MEDICARE: DR. PRADEEPIKA NELUMDNI SAMARANAYAKE

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	156F00000X	Technician/Technologist		TX

General Provider Information

NPI Number	:	1235063561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRADEEPIKA NELUMDNI SAMARANAYAKE

Provider Business Mailing Address
First Line	:	3500 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2644
Country	:	US
Telephone Number	:	817-585-0464
Fax Number	:	817-585-0464

Provider Business Practice Location Address
First Line	:	3500 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2644
Country	:	US
Telephone Number	:	817-585-0464
Fax Number	:	817-585-0464

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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