Individual
DR. HIMALI JAYAKODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
170 PINE AVE N, OLDSMAR, FL 34677-4629
(480) 652-2110
Mailing address
170 PINE AVE N, OLDSMAR, FL 34677-4629
(813) 553-4448
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R- 8547
IA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
ME119541
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105381800
—
FL
01
—
I4V0M
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/06/2009
Last updated
12/03/2024
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