Provider Demographics
NPI:1114083003
Name:ARULPRAGASAM, DARINI SHEREEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARINI
Middle Name:SHEREEN
Last Name:ARULPRAGASAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W TOMARAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9421
Mailing Address - Country:US
Mailing Address - Phone:217-649-4431
Mailing Address - Fax:217-398-0413
Practice Address - Street 1:701 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7337
Practice Address - Country:US
Practice Address - Phone:217-359-8637
Practice Address - Fax:217-398-0413
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004982103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
204719Medicare ID - Type Unspecified