Healthcare Provider Details

I. General information

NPI: 1659807097
Provider Name (Legal Business Name): CHATHURA SANKALPA WIJEWARDENA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 SOUTHWESTERN BLVD STE 100
ORCHARD PARK NY
14127-1231
US

IV. Provider business mailing address

3055 SOUTHWESTERN BLVD STE 100
ORCHARD PARK NY
14127-1231
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number334407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: