Provider Demographics
NPI:1164473492
Name:GUNASEKERA, SANDYA I (MD)
Entity Type:Individual
Prefix:
First Name:SANDYA
Middle Name:I
Last Name:GUNASEKERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDYA
Other - Middle Name:
Other - Last Name:SYMATHIPALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-288-1928
Mailing Address - Fax:765-741-0340
Practice Address - Street 1:240 N TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3988
Practice Address - Country:US
Practice Address - Phone:765-288-1928
Practice Address - Fax:765-741-0340
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058723A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN945350XXMedicare ID - Type Unspecified