Provider Demographics
NPI:1659097517
Name:MENDIS, YASOBHA FERNANDO (AGNP-C)
Entity Type:Individual
Prefix:
First Name:YASOBHA
Middle Name:FERNANDO
Last Name:MENDIS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SETON DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3232
Mailing Address - Country:US
Mailing Address - Phone:410-358-3410
Mailing Address - Fax:
Practice Address - Street 1:4800 SETON DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3232
Practice Address - Country:US
Practice Address - Phone:410-358-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224081363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health