Provider Demographics
NPI:1235893470
Name:GOONAWARDENA, THILINI LANKIKA
Entity Type:Individual
Prefix:
First Name:THILINI
Middle Name:LANKIKA
Last Name:GOONAWARDENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ESCANABA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1931
Mailing Address - Country:US
Mailing Address - Phone:347-995-8777
Mailing Address - Fax:
Practice Address - Street 1:37 ESCANABA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1931
Practice Address - Country:US
Practice Address - Phone:347-995-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY769103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse