Provider Demographics
NPI:1871528430
Name:DHAYAPARAN, SELLATHURAI K (MD)
Entity type:Individual
Prefix:
First Name:SELLATHURAI
Middle Name:K
Last Name:DHAYAPARAN
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 1:14203 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5301
Mailing Address - Country:US
Mailing Address - Phone:718-353-0533
Mailing Address - Fax:718-353-0506
Practice Address - Street 1:14203 60TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5301
Practice Address - Country:US
Practice Address - Phone:718-353-0533
Practice Address - Fax:718-353-0506
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239481208000000X, 207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG67904Medicare UPIN
NY34N231Medicare ID - Type Unspecified