Provider Demographics
NPI:1578504957
Name:DE SOYZA, SHANILKA N (MD)
Entity type:Individual
Prefix:DR
First Name:SHANILKA
Middle Name:N
Last Name:DE SOYZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8624
Mailing Address - Country:US
Mailing Address - Phone:541-737-9355
Mailing Address - Fax:541-737-9694
Practice Address - Street 1:850 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8624
Practice Address - Country:US
Practice Address - Phone:541-737-9355
Practice Address - Fax:541-737-9694
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG26881Medicare UPIN