Provider Demographics
NPI:1417690876
Name:BISWAS, SUDAKSHINA NONE (APN)
Entity Type:Individual
Prefix:MRS
First Name:SUDAKSHINA
Middle Name:NONE
Last Name:BISWAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:SHEENA
Other - Middle Name:
Other - Last Name:BISWAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:904 BAYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1065
Mailing Address - Country:US
Mailing Address - Phone:309-992-0593
Mailing Address - Fax:
Practice Address - Street 1:8600 ILLINOIS ROUTE-91, SUITE 130 OSF INTERNAL MED
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-683-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine