Provider Demographics
NPI:1669834818
Name:DEWASURENDRA, ANUSARI
Entity Type:Individual
Prefix:
First Name:ANUSARI
Middle Name:
Last Name:DEWASURENDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANU
Other - Middle Name:
Other - Last Name:DEWASURENDRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:405 GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2411
Mailing Address - Country:US
Mailing Address - Phone:734-717-4088
Mailing Address - Fax:
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:734-717-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30392207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine