Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R- 8547 | IA |
Y | 2084N0402X | Child Neurologist | ME119541 | FL |
NPI | 1346479854 |
---|---|
Provider Name | Dr. Himali Renuka Jayakody |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2009 |
Last Update Date | 10/08/2016 |