Provider Demographics
NPI:1275500712
Name:DAYARATNA, SANDRA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:D
Last Name:DAYARATNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4420
Mailing Address - Country:US
Mailing Address - Phone:215-955-5000
Mailing Address - Fax:215-923-1089
Practice Address - Street 1:833 CHESTNUT STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4420
Practice Address - Country:US
Practice Address - Phone:215-955-5000
Practice Address - Fax:215-923-1089
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206983207V00000X
OH35-088723207V00000X
PAMD437090207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
206983OtherMA LICENCE
OHP00422677OtherRAILROAD MEDICARE
OH000000221069OtherUNISON
7400041OtherEVERCARE
OH000000509157OtherANTHEM
51020OtherFALLON
7228135OtherAETNA NON HMO
OH7228135OtherAETNA
OH740798OtherBUCKEYE
J22704OtherBLUE CARE ELECT
1895243OtherFIRST HEALTH
206983OtherMEDICARE PREFERRED/TUFTS
OH2703873Medicaid
9676427001OtherCIGNA
2339545OtherAETNA HMO
OH414958OtherWELLCARE
J22704OtherHMO BLUE
OH000000509157OtherANTHEM
206983OtherMEDICARE PREFERRED/TUFTS
OHDA4197952Medicare PIN