Provider Demographics
NPI:1164497343
Name:SIVENDRAN, SIVALINGAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVALINGAM
Middle Name:
Last Name:SIVENDRAN
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER WAY
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2255
Practice Address - Country:US
Practice Address - Phone:607-936-9971
Practice Address - Fax:607-936-2600
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237393-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680739Medicaid
NYP00324447OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
NYP00324447OtherRR MEDICARE PIN
NYRA8368Medicare PIN