Healthcare Provider Details

I. General information

NPI: 1700232154
Provider Name (Legal Business Name): RAKSHIKA RAJAKARUNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/09/2021
Certification Date: 05/09/2021
Deactivation Date: 12/30/2016
Reactivation Date: 03/09/2017

III. Provider practice location address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

IV. Provider business mailing address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax:
Mailing address:
  • Phone: 716-632-1088
  • Fax: 716-632-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number310216
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: