Provider Demographics
NPI:1407460322
Name:SIVANANDAN, DEVI
Entity Type:Individual
Prefix:MRS
First Name:DEVI
Middle Name:
Last Name:SIVANANDAN
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 1:4 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3337
Mailing Address - Country:US
Mailing Address - Phone:857-225-3948
Mailing Address - Fax:
Practice Address - Street 1:18 DALE ST UNIT 5C
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5663
Practice Address - Country:US
Practice Address - Phone:857-225-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2297068363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health