Provider Demographics
NPI:1609251362
Name:GUNAWARDENA, SHANITHA NIMALI
Entity type:Individual
Prefix:
First Name:SHANITHA
Middle Name:NIMALI
Last Name:GUNAWARDENA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHANITHA
Other - Middle Name:NIMALI
Other - Last Name:GUNAWARDENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10716 LA TUNA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2130
Mailing Address - Country:US
Mailing Address - Phone:818-252-5863
Mailing Address - Fax:
Practice Address - Street 1:10716 LA TUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2130
Practice Address - Country:US
Practice Address - Phone:818-252-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA 31092355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASPA 3109OtherCALIFORNIA STATE LICENSE NUMBER SLPA