Provider Demographics
NPI:1437033180
Name:MALLIKARACHCHI, IVANKA
Entity type:Individual
Prefix:
First Name:IVANKA
Middle Name:
Last Name:MALLIKARACHCHI
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 1:2728 GARRETT NICHOLAS LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3593
Mailing Address - Country:US
Mailing Address - Phone:407-705-4917
Mailing Address - Fax:
Practice Address - Street 1:4964 N PALM AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9111
Practice Address - Country:US
Practice Address - Phone:321-228-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician