Provider Demographics
NPI:1689136749
Name:BANDARANAYAKE, DINUSHA INDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:DINUSHA
Middle Name:INDRA
Last Name:BANDARANAYAKE
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 1:1266 N SANDECKER LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-3337
Mailing Address - Country:US
Mailing Address - Phone:520-203-7518
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE STE 2M206
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant