Provider Demographics
NPI:1215190244
Name:WIJEMANNE, SUBHASHIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHASHIE
Middle Name:
Last Name:WIJEMANNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUBHASHIE
Other - Middle Name:
Other - Last Name:WIJEMANNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6618 SITIO DEL RIO BLVD STE D102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1148
Mailing Address - Country:US
Mailing Address - Phone:512-241-1567
Mailing Address - Fax:512-241-1685
Practice Address - Street 1:6618 SITIO DEL RIO BLVD STE D102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1148
Practice Address - Country:US
Practice Address - Phone:512-241-1567
Practice Address - Fax:512-241-1685
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP34402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology