MEDICARE: DR. SAMANTHA DAYAWANSA MD

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	207T00000X	Neurological Surgery Physician	95099	GA
2	207T00000X	Neurological Surgery Physician	V8608	TX
3	207T00000X	Neurological Surgery Physician	01096248A	IN

General Provider Information

NPI Number	:	1376980649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA DAYAWANSA MD

Provider Business Mailing Address
First Line	:	5500 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1372
Country	:	US
Telephone Number	:	936-560-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1372
Country	:	US
Telephone Number	:	936-560-6999
Fax Number	:

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

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	01/13/2026

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