Provider Demographics
NPI:1689136749
Name:BANDARANAYAKE, DINUSHA INDRA (PA-C)
Entity type:Individual
Prefix:
First Name:DINUSHA
Middle Name:INDRA
Last Name:BANDARANAYAKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:10815 W MCDOWELL RD STE 301
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5016
Practice Address - Country:US
Practice Address - Phone:623-433-0106
Practice Address - Fax:623-535-0741
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2025-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZPA57367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant