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General NPI Number Information
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NPI Number | 1457771305
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Entity Type | Individual
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Provider Name | TAMARA RENEE SANDERSON DISSANAYAKE MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 703 NE HANCOCK ST
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City | PORTLAND
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State | OR
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Zip | 97212-3955
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Country | US
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Telephone | 503-230-9875
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Fax | 503-331-3441
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Provider Business Mailing Address
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Address Line | 211 SE CARUTHERS ST
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City | PORTLAND
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State | OR
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Zip | 97214-4502
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Country | US
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Telephone | 503-224-1044
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Fax | 971-260-0355
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61333136
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD175860
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License Number State | OR
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