Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 042331 | CT |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 042331 | CT |
NPI | 1073519583 |
---|---|
Provider Name | Dr. Shirvinda A Wijesekera |
First Address | Hamden, CT 06518-3267 |
Second Address | Hamden, CT 06518-3267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H85164 | (02) | CT |