Healthcare Provider Details

I. General information

NPI: 1689672933
Provider Name (Legal Business Name): SUNITHA NAIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST STE 210
PEORIA IL
61602-5005
US

IV. Provider business mailing address

900 MAIN ST STE 210
PEORIA IL
61602-5005
US

V. Phone/Fax

Practice location:
  • Phone: 224-522-9945
  • Fax: 309-672-4552
Mailing address:
  • Phone: 224-522-9945
  • Fax: 309-672-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number036108897
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberV2538
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number69845
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69845-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: