Provider Demographics
NPI:1659690253
Name:BODHINAYAKE, IMITHRI NIMSHANI DESILVA
Entity Type:Individual
Prefix:
First Name:IMITHRI
Middle Name:NIMSHANI DESILVA
Last Name:BODHINAYAKE
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 1:1249 PARK AVE
Mailing Address - Street 2:APT 14 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7219
Mailing Address - Country:US
Mailing Address - Phone:949-300-7401
Mailing Address - Fax:
Practice Address - Street 1:1249 PARK AVE
Practice Address - Street 2:APT 14 D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7219
Practice Address - Country:US
Practice Address - Phone:949-300-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program