Provider Demographics
NPI:1942099676
Name:HEWAGE, A SHAVINI NEERADHA
Entity type:Individual
Prefix:
First Name:A SHAVINI
Middle Name:NEERADHA
Last Name:HEWAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAVI
Other - Middle Name:
Other - Last Name:HEWAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2452 HAMMOCK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6008
Mailing Address - Country:US
Mailing Address - Phone:214-228-6517
Mailing Address - Fax:
Practice Address - Street 1:5016 S US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:903-416-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program