Individual provider Active NPI

Shanaka L. Weerasooriya, DMD

  • General Practice Dentistry
  • Englewood, FL
National Provider Identifier
1922012988
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
15514 Issued in FL
Practice address
1861 Placida Rd
Suite 105
Englewood, FL 34223-4961
Phone
(941) 474-9548
Fax
(941) 475-6745
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 15514 FL Primary

Addresses

Primary practice location

1861 Placida Rd
Suite 105
Englewood, FL 34223-4961

Mailing address

1861 Placida Rd
Suite 105
Englewood, FL 34223-4961
Phone (941) 474-9548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160623002223 FL Order and Referring Only - DentistPractitioner - Dentist 3870884760

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15514FLMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922012988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1861 PLACIDA RD",
            "address_2": "SUITE 105",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234961",
            "telephone_number": "941-474-9548",
            "fax_number": "941-475-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1861 PLACIDA RD",
            "address_2": "SUITE 105",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234961",
            "telephone_number": "941-474-9548",
            "fax_number": "941-475-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEERASOORIYA",
        "first_name": "SHANAKA",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "15514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, FL

Sources for this page

Verify at the official NPI Registry.