Provider Demographics
NPI:1407944002
Name:DE SILVA, NEELANTHA MENAKA (MD)
Entity type:Individual
Prefix:
First Name:NEELANTHA
Middle Name:MENAKA
Last Name:DE SILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MENAKA
Other - Middle Name:NEELANTHA
Other - Last Name:DESILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1140 W LA VETA AVE STE 730
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4229
Mailing Address - Country:US
Mailing Address - Phone:714-541-6800
Mailing Address - Fax:714-541-1119
Practice Address - Street 1:11215 METRO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA689172084N0400X
AZ754102084N0400X
MO20240484332084N0400X
FLME1719582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH82705Medicare UPIN
CAWA68917AMedicare PIN