Provider Demographics
NPI:1689991564
Name:SUNKIREDDY, NANDINI (MD)
Entity type:Individual
Prefix:
First Name:NANDINI
Middle Name:
Last Name:SUNKIREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 CLARION ST, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-4946
Mailing Address - Country:US
Mailing Address - Phone:770-764-1234
Mailing Address - Fax:770-215-1862
Practice Address - Street 1:5820 CLARION ST STE 101
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-0389
Practice Address - Country:US
Practice Address - Phone:770-764-1234
Practice Address - Fax:770-215-1862
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA76688207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA206195OtherMEDICAL LICENSE NUMBER