Provider Demographics
NPI:1205883592
Name:MOHAN, SASIKALA (MD)
Entity type:Individual
Prefix:DR
First Name:SASIKALA
Middle Name:
Last Name:MOHAN
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 1:560 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5027
Mailing Address - Country:US
Mailing Address - Phone:516-933-2800
Mailing Address - Fax:516-933-2809
Practice Address - Street 1:4355 147TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1736
Practice Address - Country:US
Practice Address - Phone:718-762-0900
Practice Address - Fax:718-886-5659
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10672545OtherCAQH
NYA60463Medicare UPIN
NY10D392Medicare ID - Type Unspecified
NY00849138Medicare ID - Type Unspecified