MEDICARE: CHANDANA DISSANAYAKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse	865118-01	NY

General Provider Information

NPI Number	:	1184575839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDANA DISSANAYAKE

Provider Business Mailing Address
First Line	:	40 COLLFIELD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2416
Country	:	US
Telephone Number	:	347-965-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 BROADHOLLOW RD STE 201
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4833
Country	:	US
Telephone Number	:	914-216-7585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ CHANDANA DISSANAYAKE ” Practice Location

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