Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME91341 | FL |
Y | 111NI0900X | Internist | ME91341 | FL |
N | 207RA0201X | Internist - Allergy & Immunology | ME91341 | FL |
N | 207RR0500X | Rheumatology | ME91341 | FL |
NPI | 1821183302 |
---|---|
Provider Name | Dr. Ginige Swanthri Desilva |
First Address | St Petersburg, FL 33708-3354 |
Second Address | St Petersburg, FL 33708-3354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 12/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I27527 | (02) | FL |