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General NPI Number Information
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NPI Number | 1346479854
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Entity Type | Individual
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Provider Name | HIMALI JAYAKODY MD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 170 PINE AVE N
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City | OLDSMAR
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State | FL
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Zip | 34677-4629
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Country | US
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Telephone | 480-652-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 170 PINE AVE N
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City | OLDSMAR
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State | FL
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Zip | 34677-4629
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Country | US
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Telephone | 813-553-4448
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R- 8547
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | ME119541
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License Number State | FL
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