Provider Demographics
NPI: | 1144725136 |
---|---|
Name: | DAYARATNA, SASHI M (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | SASHI |
Middle Name: | M |
Last Name: | DAYARATNA |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | SASHI |
Other - Middle Name: | |
Other - Last Name: | ABEYSEKARA |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 37174 |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21297-3174 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 571-423-5699 |
Mailing Address - Fax: | 571-423-5698 |
Practice Address - Street 1: | 2700 PROSPERITY AVE STE 270 |
Practice Address - Street 2: | |
Practice Address - City: | FAIRFAX |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22031-4321 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-698-2431 |
Practice Address - Fax: | 571-665-6878 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-03-29 |
Last Update Date: | 2022-11-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
390200000X | ||
VA | 0101275790 | 207RG0300X, 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |