Individual
DR. PRAVEEN SHILPA FERNANDOPULLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MOUNTAIN HOME VA MEDICAL CENTER, 69 DOGWOOD LN, JOHNSON CITY, TN 37604
(646) 250-4442
Mailing address
1721 SKYLINE DR APT 200, JOHNSON CITY, TN 37604-3786
(646) 250-4442
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
67452
TN
Other
Enumeration date
04/25/2019
Last updated
08/23/2023
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