Basic Information
| Provider Information | |||||||||
| NPI: | 1265402861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EKANAYAKE | ||||||||
| FirstName: | IRANI | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 813 ROLLING MEADOWS CT | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750135465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146200813 | ||||||||
| FaxNumber: | 9729083568 | ||||||||
| Practice Location | |||||||||
| Address1: | 813 ROLLING MEADOWS CT | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750135465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146200813 | ||||||||
| FaxNumber: | 9729083568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N0746 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA06879100 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 8F24341 | 01 | TX | MEDICARE ID | OTHER | 8F24341 | 01 | TX | TEXAS MEDICARE ID | OTHER |