Desilva, Sujatha Hettiarachchi
Desilva, Sujatha Hettiarachchi is an sole proprietor health care provider with primary practice located at 141 Pike St , Port Jervis NY 12771-1807. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Desilva, Sujatha Hettiarachchi can be contacted via phone (845) 856-4002.Contact Information
Primary practice address
141 Pike St
Port Jervis NY 12771-1807
Phone: (845) 856-4002
Fax: (845) 858-1127
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 039885 | New York |
Profile Details
| NPI number | 1639251846 |
|---|---|
| LBN Legal business name | Desilva, Sujatha Hettiarachchi |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 19th, 2006 |
| Last updated | Jan 25th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639251846 | NPPES |
| New York | MEDICAID | 03143299 |
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