Provider Demographics
NPI:1730605056
Name:ABEYADEERA, SANJAY NIMALI (FNP)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:NIMALI
Last Name:ABEYADEERA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24275 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7267
Mailing Address - Country:US
Mailing Address - Phone:346-387-7171
Mailing Address - Fax:844-703-5305
Practice Address - Street 1:24275 KATY FWY STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7267
Practice Address - Country:US
Practice Address - Phone:346-387-7171
Practice Address - Fax:844-703-5305
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty