Provider Demographics
NPI:1356342497
Name:GAJAWEERA, ASHANTHI (MD)
Entity type:Individual
Prefix:
First Name:ASHANTHI
Middle Name:
Last Name:GAJAWEERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HAGEN DR.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-586-7550
Mailing Address - Fax:585-586-7588
Practice Address - Street 1:20 HAGEN DR.
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-586-7550
Practice Address - Fax:585-586-7588
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2290952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02442015Medicaid
NY02442015Medicaid
NYH93166Medicare UPIN