Healthcare Provider Details

I. General information

NPI: 1114083003
Provider Name (Legal Business Name): DARINI SHEREEN ARULPRAGASAM PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DEVONSHIRE DR
CHAMPAIGN IL
61820-7337
US

IV. Provider business mailing address

408 W TOMARAS AVE
SAVOY IL
61874-9421
US

V. Phone/Fax

Practice location:
  • Phone: 217-359-8637
  • Fax: 217-398-0413
Mailing address:
  • Phone: 217-649-4431
  • Fax: 217-398-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071004982
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071004982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: