Provider Demographics
NPI:1174885370
Name:MOODLEY, SASHIDARAN MANIKUM (MD)
Entity type:Individual
Prefix:DR
First Name:SASHIDARAN
Middle Name:MANIKUM
Last Name:MOODLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5145
Mailing Address - Country:US
Mailing Address - Phone:312-982-1242
Mailing Address - Fax:
Practice Address - Street 1:108 WILMOT RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5145
Practice Address - Country:US
Practice Address - Phone:312-982-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine