Provider Demographics
NPI:1063154136
Name:JAYAWICKREME, DUNUWILLE AVINDA NUWAN (PHD)
Entity type:Individual
Prefix:DR
First Name:DUNUWILLE
Middle Name:AVINDA NUWAN
Last Name:JAYAWICKREME
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PLUMLY WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-5500
Mailing Address - Country:US
Mailing Address - Phone:267-307-4612
Mailing Address - Fax:
Practice Address - Street 1:1910 ROUTE 70 E STE 7&5
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2123
Practice Address - Country:US
Practice Address - Phone:856-220-9672
Practice Address - Fax:856-673-0630
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00654100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty