Individual
NILUSHA TANIA FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
325 WAYMONT CT STE 111, LAKE MARY, FL 32746-3572
(407) 936-3345
Mailing address
325 WAYMONT CT STE 111, LAKE MARY, FL 32746-3572
(407) 936-3345
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
OS10654
FL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
OS10654
FL
Other
Enumeration date
04/03/2007
Last updated
10/06/2022
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