Provider Demographics
NPI:1396132999
Name:FERNANDO, PRASANNA DAYAN
Entity type:Individual
Prefix:DR
First Name:PRASANNA
Middle Name:DAYAN
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAYAN
Other - Middle Name:PRASANNA
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 720006
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4006
Mailing Address - Country:US
Mailing Address - Phone:405-624-8222
Mailing Address - Fax:
Practice Address - Street 1:1411 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4300
Practice Address - Country:US
Practice Address - Phone:405-624-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31231207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology