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General NPI Number Information
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NPI Number | 1649583410
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Entity Type | Individual
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Provider Name | AMA SHANKINI WIJEGUNAWARDENA MD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 9300 VALLEY CHILDRENS PL
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City | MADERA
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State | CA
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Zip | 93636-8761
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Country | US
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Telephone | 347-638-4126
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 E SHEPHERD AVE APT 107
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City | FRESNO
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State | CA
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Zip | 93720-5615
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Country | US
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Telephone | 347-638-4126
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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 | A125459
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License Number State | CA
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