MEDICARE: SAILAJA MUSUNURI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA11355800	NJ
2	2084P0804X	Child & Adolescent Psychiatry Physician	25MA11355800	NJ
3	2084P0804X	Child & Adolescent Psychiatry Physician	MD072136L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407839368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAILAJA MUSUNURI MD

Provider Business Mailing Address
First Line	:	527 DUBLIN DRIVE
Second Line	:
City	:	DOWNINGTON
State	:	PA
Zip	:	19335
Country	:	US
Telephone Number	:	484-432-1857
Fax Number	:	610-594-2561

Provider Business Practice Location Address
First Line	:	8TH AVENUE & HAY RD
Second Line	:	KIDSPEACE NATIONAL CENTERS BERKS CAMPUS
City	:	TEMPLE
State	:	PA
Zip	:	19560
Country	:	US
Telephone Number	:	610-929-4670
Fax Number	:	610-929-4686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	08/04/2025

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