Provider Demographics
NPI:1124272976
Name:WIMALAWANSA, SUNISHKA M (MD, MBA)
Entity type:Individual
Prefix:
First Name:SUNISHKA
Middle Name:M
Last Name:WIMALAWANSA
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Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:580 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3474
Mailing Address - Country:US
Mailing Address - Phone:937-949-8457
Mailing Address - Fax:937-949-8695
Practice Address - Street 1:580 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3474
Practice Address - Country:US
Practice Address - Phone:937-949-8457
Practice Address - Fax:937-949-8695
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.0970242086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery