Individual
PRABATH MADUSANKA HERATH MUDIYANSELAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10401 W THUNDERBIRD BLVD, SUN CITY, AZ 85351-3004
(623) 832-4728
Mailing address
10401 W THUNDERBIRD BLVD, SUN CITY, AZ 85351-3004
(623) 832-4728
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
58.030211
OH
208M00000X
Hospitalist Physician
Primary
009089
AZ
Other
Enumeration date
07/09/2018
Last updated
01/15/2025
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