Individual
AYESHA I PATABENDI KORALALAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
26 DUMONT AVE, STATEN ISLAND, NY 10305-1450
(718) 667-8510
Mailing address
34A GREENTREE LN, STATEN ISLAND, NY 10314-1601
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
332594-1
NY
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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