Provider Demographics
NPI:1518765031
Name:MADAWALA, NETH SUVINDU
Entity type:Individual
Prefix:
First Name:NETH
Middle Name:SUVINDU
Last Name:MADAWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 TROWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5220
Mailing Address - Country:US
Mailing Address - Phone:947-233-0024
Mailing Address - Fax:
Practice Address - Street 1:1040 TROWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5220
Practice Address - Country:US
Practice Address - Phone:947-233-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant