Provider Demographics
NPI:1992106686
Name:GUNAWARDANE, NISALI (MD)
Entity type:Individual
Prefix:
First Name:NISALI
Middle Name:
Last Name:GUNAWARDANE
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 1:755 N BROADWAY STE 430
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1077
Mailing Address - Country:US
Mailing Address - Phone:914-366-5300
Mailing Address - Fax:914-366-5300
Practice Address - Street 1:755 N BROADWAY STE 430
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1077
Practice Address - Country:US
Practice Address - Phone:914-366-5300
Practice Address - Fax:914-366-5301
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293044-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology