Provider Demographics
NPI:1376586800
Name:SAKYIAMA, THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:SAKYIAMA
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 1:0N202 WOODLAND CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3030
Mailing Address - Country:US
Mailing Address - Phone:319-610-0289
Mailing Address - Fax:630-376-7595
Practice Address - Street 1:2100 MANCHESTER RD STE 1510
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4561
Practice Address - Country:US
Practice Address - Phone:630-653-1717
Practice Address - Fax:630-653-7926
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361234162084P0804X
IA355532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0434027Medicaid
IAI04647Medicare UPIN
IA0434027Medicaid