Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301109775 | MI |
Y | 2080A0000X | Adolescent Medicine | 4301117290 | MI |
NPI | 1003266545 |
---|---|
Provider Name | Vishvanie Bernadene Jayasundera |
First Address | Ann Arbor, MI 48109-5718 |
Second Address | Ann Arbor, MI 48109-5718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 30/07/2019 |