Healthcare Provider Details

I. General information

NPI: 1356342497
Provider Name (Legal Business Name): ASHANTHI GAJAWEERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 EAST AVENUE, 4TH FLOOR
ROCHESTER NY
14610
US

IV. Provider business mailing address

2290 EAST AVENUE, 4TH FLOOR
ROCHESTER NY
14610
US

V. Phone/Fax

Practice location:
  • Phone: 585-201-8478
  • Fax: 800-396-8709
Mailing address:
  • Phone: 585-201-8478
  • Fax: 800-396-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number229095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: