Provider Demographics
NPI:1922158666
Name:ESWARATHASAN, SATHIYAPAMA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SATHIYAPAMA
Middle Name:
Last Name:ESWARATHASAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-691-9197
Mailing Address - Fax:203-496-4580
Practice Address - Street 1:2 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-691-9197
Practice Address - Fax:203-496-4580
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00000213E00000X
CT000901213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PK1091Medicare ID - Type Unspecified