Provider Demographics
NPI:1942353230
Name:DESILVA, GAYANI VATSALA (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYANI
Middle Name:VATSALA
Last Name:DESILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GAYANI
Other - Middle Name:DESILVA
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6325 TIBURON TER
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6558
Mailing Address - Country:US
Mailing Address - Phone:714-944-4856
Mailing Address - Fax:
Practice Address - Street 1:32392 COAST HWY
Practice Address - Street 2:STE 250
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6776
Practice Address - Country:US
Practice Address - Phone:949-499-2265
Practice Address - Fax:949-499-2276
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA819162084P0804X, 2084P0800X
NMMD2008-08222084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM25531824Medicaid