Individual
SHANIK J FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9427 SW BARNES RD STE 395, PORTLAND, OR 97225-6652
(503) 216-6050
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
MD209961
OR
Other
Enumeration date
05/02/2016
Last updated
10/27/2022
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