MEDICARE: ANJALI SUNDARAMOORTHY DO

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	390200000X	Student in an Organized Health Care Education/Training Program	S082795972	OK
2	2084N0400X	Neurology Physician	T9509	TX

General Provider Information

NPI Number	:	1720511702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJALI SUNDARAMOORTHY DO

Provider Business Mailing Address
First Line	:	9101 N CENTRAL EXPY STE 40
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 N CENTRAL EXPY STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-6009
Country	:	US
Telephone Number	:	918-261-5198
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	10/10/2022

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