Sirisha Mandadi, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

021002794 Issued in IL

Practice address

2241 Theodore St
Crest Hill, IL 60403-1881

Phone

(815) 741-1700

Fax

(815) 741-8511

NPI assigned

Feb 6, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1215209366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4627 CEDAR DR",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605641155",
            "telephone_number": "203-921-5269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2241 THEODORE ST",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604031881",
            "telephone_number": "815-741-1700",
            "fax_number": "815-741-8511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "91 East Ave",
            "address_2": "3rd Floor",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068515020",
            "country_code": "US",
            "telephone_number": "203-299-0111",
            "fax_number": "203-286-1163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANDADI",
        "first_name": "SIRISHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-06",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "WI",
            "license": "1001977",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "IL",
            "license": "021002794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karina Lopez
• M. M. Ahsan S.C.
• Xiaoyu Ma
• Kelli Majka
• Catherine Malooly, MPT
• Shwetha Manjunath, MD
• Jena L. Margis, CADC
• Mariusz Rogalski, MD, SC
• Mirella Martinez, LSW
• Stacey Anne Matson, LPC

• Prosthodontics in Crest Hill, IL
• Providers in Crest Hill, IL by specialty
• Prosthodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.