Provider Demographics
NPI:1063845568
Name:WIJESINGHE KANNANGARA, RASHINI RUMESHA (DPM)
Entity Type:Individual
Prefix:
First Name:RASHINI
Middle Name:RUMESHA
Last Name:WIJESINGHE KANNANGARA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 BELLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5651
Mailing Address - Country:US
Mailing Address - Phone:516-308-4500
Mailing Address - Fax:
Practice Address - Street 1:5316 ROOSEVELT AVE STE 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4239
Practice Address - Country:US
Practice Address - Phone:718-672-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006754-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist