Provider Demographics
NPI:1528845575
Name:NIWUNHELLA, NA DON CHALITHARANGA
Entity type:Individual
Prefix:
First Name:NA DON CHALITHARANGA
Middle Name:
Last Name:NIWUNHELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NIWUNHELLA
Other - Middle Name:APPUHAMIL
Other - Last Name:NIWUNHELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:475 NORTHERN BLVD STE 27
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20832 CROSS ISLAND PKWY # 32
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1187
Practice Address - Country:US
Practice Address - Phone:516-829-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist