Healthcare Provider Details

I. General information

NPI: 1003497330
Provider Name (Legal Business Name): NEESHA CHANDANI SIRIWARDANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-2703
US

IV. Provider business mailing address

848 TIJERAS AVE NW UNIT A
ALBUQUERQUE NM
87102-3142
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6225
  • Fax:
Mailing address:
  • Phone: 318-548-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberMD2025-0121
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: