Provider Demographics
NPI:1881237360
Name:BANDARANAYAKE, DAKSHIKA WIJAYANTHIE
Entity type:Individual
Prefix:
First Name:DAKSHIKA
Middle Name:WIJAYANTHIE
Last Name:BANDARANAYAKE
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 1:9850 MELODY DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-6902
Mailing Address - Country:US
Mailing Address - Phone:513-658-2098
Mailing Address - Fax:
Practice Address - Street 1:90 ALEXANDRIA PIKE STE 4-7
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4108
Practice Address - Country:US
Practice Address - Phone:859-442-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist