Provider Demographics
NPI:1891040630
Name:SIVARAJAH, THARENIE (MD)
Entity Type:Individual
Prefix:
First Name:THARENIE
Middle Name:
Last Name:SIVARAJAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 EAST 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4797
Mailing Address - Country:US
Mailing Address - Phone:307-632-2434
Mailing Address - Fax:307-634-3510
Practice Address - Street 1:820 EAST 17TH STREET
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4797
Practice Address - Country:US
Practice Address - Phone:307-632-2434
Practice Address - Fax:307-634-3510
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293430207Q00000X
WY032-T2207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine