Sujatha Sekar Sivaraman, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2024008518 Issued in MO

Practice address

2475 Broadway Bluffs Dr
Columbia, MO 65201-8148

Phone

(573) 777-9282

Fax

(573) 777-9569

NPI assigned

Oct 26, 2005

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

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": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1477543932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W WORLEY ST",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652032037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 BROADWAY BLUFFS DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652018148",
            "telephone_number": "573-777-9282",
            "fax_number": "573-777-9569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVARAMAN",
        "first_name": "SUJATHA",
        "middle_name": "SEKAR",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-26",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MO",
            "license": "2005026619",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MO",
            "license": "2024008518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor John Sirois, DC
• Sisters Supportive Living, Inc.
• Shannon Rhea Sitzmann, DNP, APRN, FNP-BC
• Chokkalingam Siva, M.D.
• Manjamalai Sivaraman, M.D.
• Beth Ann Sjoblom, MD
• Austin Skinner, DO
• Jamie L Skinner, LMSW
• Jeremy Burr Skinner, PH.D.
• Ryan Michael Skinner

• Pediatric Dentistry in Columbia, MO
• Providers in Columbia, MO by specialty
• Pediatric Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.