Healthcare Provider Details

I. General information

NPI: 1043508070
Provider Name (Legal Business Name): SULAGSHAN MAHENDRARAJAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MING AVE STE 485
BAKERSFIELD CA
93309-9119
US

IV. Provider business mailing address

5500 MING AVE STE 485
BAKERSFIELD CA
93309-9119
US

V. Phone/Fax

Practice location:
  • Phone: 319-383-1834
  • Fax:
Mailing address:
  • Phone: 319-383-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-9294
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM-17549
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberT2672
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC-193029
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD170301
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: