Provider Demographics
NPI:1346988623
Name:SADIKOT, MARIYAM
Entity Type:Individual
Prefix:
First Name:MARIYAM
Middle Name:
Last Name:SADIKOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 KING LOUIS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1600
Mailing Address - Country:US
Mailing Address - Phone:224-291-4456
Mailing Address - Fax:
Practice Address - Street 1:600 NW MURRAY RD STE 201
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1227
Practice Address - Country:US
Practice Address - Phone:913-222-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program