Individual
ASITHA DINETH LIBBEY JAYAWARDENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 874-1292
(612) 813-6889
Mailing address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 874-1292
(612) 813-6889
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
NA
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2014
Last updated
05/16/2020
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