Basic Information
| Provider Information | |||||||||
| NPI: | 1801964028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAHATAPITIYA | ||||||||
| FirstName: | DILRUKSHIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 CLEVELAND ST | ||||||||
| Address2: | SUITE 228 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234621752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574992825 | ||||||||
| FaxNumber: | 7574994248 | ||||||||
| Practice Location | |||||||||
| Address1: | 1708 OLD DONATION PKWY | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234543064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573955300 | ||||||||
| FaxNumber: | 7573955322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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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 | 363L00000X | 0024167158 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 10019827N | 01 | VA | OPTIMA/SENTARA | OTHER | 1801964028 | 05 | VA | MEDICAID |