Provider Demographics
NPI:1346672003
Name:SACKIRIYAS, KANIKKAI STENI BALAN (DSC)
Entity Type:Individual
Prefix:
First Name:KANIKKAI STENI BALAN
Middle Name:
Last Name:SACKIRIYAS
Suffix:
Gender:M
Credentials:DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 N PINE ISLAND RD
Mailing Address - Street 2:SHAMROCK APARTMENTS, APT 304
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6520
Mailing Address - Country:US
Mailing Address - Phone:909-991-5445
Mailing Address - Fax:
Practice Address - Street 1:1580 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2859
Practice Address - Country:US
Practice Address - Phone:800-886-8108
Practice Address - Fax:866-422-6431
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034920225100000X
VA2305207892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist