MEDICARE: SHAMOD MAHAWELA MUDIYANSELAGE

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1932047487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMOD MAHAWELA MUDIYANSELAGE

Provider Business Mailing Address
First Line	:	6587 FLINT CREEK DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8278
Country	:	US
Telephone Number	:	813-203-9240
Fax Number	:

Provider Business Practice Location Address
First Line	:	16228 STATE ROAD 54
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3729
Country	:	US
Telephone Number	:	813-475-5599
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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