Provider Demographics
NPI:1578308730
Name:SIRISENA, MAHESH NUWAN KUMARA
Entity type:Individual
Prefix:MR
First Name:MAHESH
Middle Name:NUWAN KUMARA
Last Name:SIRISENA
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 1:15 N ROBERT DAMM ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3518
Mailing Address - Country:US
Mailing Address - Phone:860-816-1033
Mailing Address - Fax:
Practice Address - Street 1:15 N ROBERT DAMM ST
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3518
Practice Address - Country:US
Practice Address - Phone:860-816-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)