Individual
HERATH MUDIYANSELAGE BANDARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MERCYHEALTH MULFORD CLINIC, 5970 CHURCHVIEW DRIVE, ROCKFORD, IL 61107
(815) 971-8990
(815) 971-9978
Mailing address
235 KAOLIN CT, ALPHARETTA, GA 30022-7365
(770) 990-6767
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/02/2025
Last updated
04/02/2025
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