Provider Demographics
NPI:1346881166
Name:SUDASINGHE, VINOSHA (PA-C)
Entity Type:Individual
Prefix:
First Name:VINOSHA
Middle Name:
Last Name:SUDASINGHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WASHINGTON ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-7027
Mailing Address - Country:US
Mailing Address - Phone:646-919-8014
Mailing Address - Fax:
Practice Address - Street 1:363 7TH AVE FL 18
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3904
Practice Address - Country:US
Practice Address - Phone:917-983-1943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant