Healthcare Provider Details

I. General information

NPI: 1659726404
Provider Name (Legal Business Name): SUJANA DONTUKURTHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

V. Phone/Fax

Practice location:
  • Phone: 559-417-3142
  • Fax:
Mailing address:
  • Phone: 559-417-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.133140
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number91934
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.133140
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number35.133140
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number73060
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number73060
License Number StateTN
# 7
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number173200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: