Provider Demographics
NPI:1215236963
Name:NDIAYE, SANDRA M (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:NDIAYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:MIKULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1900 SILVER CROSS BLVD
Mailing Address - Street 2:PEDIATRICS OFFICE #3116
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9509
Mailing Address - Country:US
Mailing Address - Phone:815-300-1100
Mailing Address - Fax:815-300-7049
Practice Address - Street 1:1900 SILVER CROSS BLVD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9509
Practice Address - Country:US
Practice Address - Phone:815-300-1100
Practice Address - Fax:815-300-7049
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007537A208M00000X
IL036134339208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist