Provider Demographics
NPI:1457889909
Name:GUNASEKERA, NICOLE (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GUNASEKERA
Suffix:
Gender:
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14305 SOUTHCROSS DR W STE 110
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7011
Mailing Address - Country:US
Mailing Address - Phone:651-340-1064
Mailing Address - Fax:651-330-0429
Practice Address - Street 1:14305 SOUTHCROSS DR W STE 110
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7011
Practice Address - Country:US
Practice Address - Phone:651-340-1064
Practice Address - Fax:651-330-0429
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA286727207N00000X
MN78388207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology