Provider Demographics
NPI:1164779245
Name:FERNANDO, LIYANAGE WIMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:LIYANAGE
Middle Name:WIMAL
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L
Other - Middle Name:W
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12808 COASTAL BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1219
Mailing Address - Country:US
Mailing Address - Phone:239-206-4499
Mailing Address - Fax:
Practice Address - Street 1:12808 COASTAL BREEZE WAY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1219
Practice Address - Country:US
Practice Address - Phone:239-206-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 75951207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology