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General NPI Number Information
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NPI Number | 1689136749
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Entity Type | Individual
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Provider Name | DINUSHA INDRA BANDARANAYAKE PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 10815 W MCDOWELL RD STE 301
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City | AVONDALE
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State | AZ
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Zip | 85392-5016
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Country | US
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Telephone | 623-433-0106
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Fax | 623-535-0741
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Provider Business Mailing Address
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Address Line | PO BOX 748817
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City | ATLANTA
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State | GA
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Zip | 30374-8817
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Country | US
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Telephone | 813-286-0033
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Fax | 813-282-1806
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA57367
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License Number State | AZ
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