Provider Demographics
NPI:1023306628
Name:IYER, SITALAKSHMI JAYAMANI (MD,)
Entity type:Individual
Prefix:DR
First Name:SITALAKSHMI
Middle Name:JAYAMANI
Last Name:IYER
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:DR
Other - First Name:SITALAKSHMI
Other - Middle Name:JAYAMANI
Other - Last Name:ROSHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:875 OAK ST SE STE 5070
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3998
Mailing Address - Country:US
Mailing Address - Phone:503-561-8565
Mailing Address - Fax:
Practice Address - Street 1:875 OAK ST SE STE 5070
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3998
Practice Address - Country:US
Practice Address - Phone:503-561-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD204176207RN0300X
CT054117207R00000X
CT1023306628390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program