Provider Demographics
NPI:1265402861
Name:EKANAYAKE, IRANI S (MD)
Entity type:Individual
Prefix:
First Name:IRANI
Middle Name:S
Last Name:EKANAYAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ROLLING MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5465
Mailing Address - Country:US
Mailing Address - Phone:214-620-0813
Mailing Address - Fax:972-908-3568
Practice Address - Street 1:813 ROLLING MEADOWS CT
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5465
Practice Address - Country:US
Practice Address - Phone:214-620-0813
Practice Address - Fax:972-908-3568
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0746207L00000X
NJ25MA06879100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F24341OtherMEDICARE ID
TX8F24341OtherTEXAS MEDICARE ID
NJG97351Medicare UPIN
NJ026584PJNMedicare ID - Type Unspecified