Provider Demographics
NPI:1538561006
Name:MANJINI SENGODAN, PRASANNA
Entity type:Individual
Prefix:
First Name:PRASANNA
Middle Name:
Last Name:MANJINI SENGODAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9407
Mailing Address - Country:US
Mailing Address - Phone:660-263-0524
Mailing Address - Fax:660-372-6407
Practice Address - Street 1:1513 UNION AVE STE 2700
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9404
Practice Address - Country:US
Practice Address - Phone:660-263-0524
Practice Address - Fax:660-372-6407
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.024476207R00000X
NC2021-02399207RI0011X
CT56786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine