Individual
PAVITHRA IRUSHI DISSANAYAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
840 MONTCLAIR RD, SUITE 317, BIRMINGHAM, AL 35213-1920
(205) 592-5135
Mailing address
1740W TAYLOR ST 3114, CHICAGO, IL 60612-7232
(312) 996-3879
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/10/2009
Last updated
11/12/2015
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