Healthcare Provider Details

I. General information

NPI: 1134331978
Provider Name (Legal Business Name): SONYA CHALASANI RAYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 N MERIDIAN ST STE 200
CARMEL IN
46032-1680
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8180
  • Fax:
Mailing address:
  • Phone: 414-326-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50284-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number50284
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01095706A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: