Provider Demographics
NPI:1740996057
Name:NIYANGODA, DUSHYANTHI MELANI
Entity type:Individual
Prefix:
First Name:DUSHYANTHI
Middle Name:MELANI
Last Name:NIYANGODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WARREN RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2429
Mailing Address - Country:US
Mailing Address - Phone:443-595-7627
Mailing Address - Fax:
Practice Address - Street 1:111 WARREN RD STE 5A
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2429
Practice Address - Country:US
Practice Address - Phone:443-595-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional