Provider Demographics
NPI:1629654116
Name:MOHOTTIGE-SEDERE, ARUNA UDANTHA
Entity Type:Individual
Prefix:MR
First Name:ARUNA
Middle Name:UDANTHA
Last Name:MOHOTTIGE-SEDERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N 300 W UNIT 2519
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2167
Mailing Address - Country:US
Mailing Address - Phone:702-237-7563
Mailing Address - Fax:
Practice Address - Street 1:2940 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6614
Practice Address - Country:US
Practice Address - Phone:801-935-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-23-69202103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst