Provider Demographics
NPI:1710483854
Name:THANGARAJAH, SASIMUGUNTHAN
Entity Type:Individual
Prefix:
First Name:SASIMUGUNTHAN
Middle Name:
Last Name:THANGARAJAH
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 1:6 WAMESIT AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3824
Mailing Address - Country:US
Mailing Address - Phone:781-350-0711
Mailing Address - Fax:
Practice Address - Street 1:6 WAMESIT AVE
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3824
Practice Address - Country:US
Practice Address - Phone:781-350-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2278005163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse