Sandra M Ndiaye, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036134339 Issued in IL

Practice address

1900 Silver Cross Blvd
New Lenox, IL 60451-9509

Phone

(815) 300-1100

Fax

(815) 300-7049

NPI assigned

Mar 21, 2011

Last updated

May 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Sandra J Mikulin Former name

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Franciscan Physician Network

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1225327984
  Medicare reassignment NPD
• Franciscan Physician Network

  • Clinic/Center
  • Lafayette, IN
  • NPI 1992543250
  NPD

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

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1215236963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER CROSS BLVD",
            "address_2": "PEDIATRICS OFFICE #3116",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519509",
            "telephone_number": "815-300-1100",
            "fax_number": "815-300-7049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER CROSS BLVD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519509",
            "telephone_number": "815-300-1100",
            "fax_number": "815-300-7049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1044 N Francisco Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606222743",
            "country_code": "US",
            "telephone_number": "773-292-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 N Winfield Rd",
            "address_purpose": "LOCATION",
            "city": "Winfield",
            "state": "IL",
            "postal_code": "601901222",
            "country_code": "US",
            "telephone_number": "630-933-1600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12750 Saint Francis Dr",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "463070264",
            "country_code": "US",
            "telephone_number": "219-757-6005",
            "fax_number": "219-681-6823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NDIAYE",
        "first_name": "SANDRA",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-21",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "02007537A",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036134339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "MIKULIN",
            "middle_name": "J",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Donna Nelligan
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• Mourice S Nemri, M.D.
• Karlynn Ness, APRN

• Pediatrics Physician in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.