Healthcare Provider Details

I. General information

NPI: 1760822738
Provider Name (Legal Business Name): SUNIL KUMAR BATLAHALLY VENKATARAYAPPA M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2013
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

IV. Provider business mailing address

5151 N 9TH AVE INTENSIVE CARE NURSERY, 2ND FLOOR
PENSACOLA FL
32504-8721
US

V. Phone/Fax

Practice location:
  • Phone: 928-779-2120
  • Fax:
Mailing address:
  • Phone: 305-206-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number18360
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number18948
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number161059
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number77319
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: