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General NPI Number Information
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NPI Number | 1639286123
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Entity Type | Individual
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Provider Name | SHARMILA D DISSANAIKE MD
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 3601 4TH ST # MS 8312
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City | LUBBOCK
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State | TX
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Zip | 79430-6340
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Country | US
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Telephone | 806-743-2164
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Fax |
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MD2004-0043
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | M7952
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M7952
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License Number State | TX
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