Healthcare Provider Details

I. General information

NPI: 1376586800
Provider Name (Legal Business Name): THERESA SAKYIAMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MANCHESTER RD STE 1510
WHEATON IL
60187-4561
US

IV. Provider business mailing address

0N202 WOODLAND CT
WHEATON IL
60187-3030
US

V. Phone/Fax

Practice location:
  • Phone: 630-653-1717
  • Fax: 630-653-7926
Mailing address:
  • Phone: 319-610-0289
  • Fax: 630-376-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036123416
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35553
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0434027
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: