Provider Demographics
NPI:1356065742
Name:EKANAYAKE, ROSHANI (PA-C)
Entity type:Individual
Prefix:
First Name:ROSHANI
Middle Name:
Last Name:EKANAYAKE
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 1:10060 DORIATH CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-9102
Mailing Address - Country:US
Mailing Address - Phone:407-870-3640
Mailing Address - Fax:
Practice Address - Street 1:10060 DORIATH CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-9102
Practice Address - Country:US
Practice Address - Phone:407-870-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116553363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical