Provider Demographics
NPI:1679265185
Name:THILAKARATHNE, MENAKA DEEPANI (MS, FNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:MENAKA
Middle Name:DEEPANI
Last Name:THILAKARATHNE
Suffix:
Gender:F
Credentials:MS, FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5108
Mailing Address - Country:US
Mailing Address - Phone:917-445-7413
Mailing Address - Fax:
Practice Address - Street 1:230 PERRY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5108
Practice Address - Country:US
Practice Address - Phone:917-445-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351387-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily