Provider Demographics
NPI:1457363830
Name:SENEVIRATNE, NAYANTARA DEEPTHI (MD)
Entity type:Individual
Prefix:
First Name:NAYANTARA
Middle Name:DEEPTHI
Last Name:SENEVIRATNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E HAMILTON AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0273
Mailing Address - Country:US
Mailing Address - Phone:408-227-2646
Mailing Address - Fax:
Practice Address - Street 1:50 E HAMILTON AVE STE 280
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0273
Practice Address - Country:US
Practice Address - Phone:408-227-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67095207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58940Medicare UPIN