Healthcare Provider Details

I. General information

NPI: 1932913357
Provider Name (Legal Business Name): SUNDARA J DEVARAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SARANAC ST
HYATTSVILLE MD
20783-2167
US

IV. Provider business mailing address

14304 DAWN WHISTLE WAY
BOWIE MD
20721
US

V. Phone/Fax

Practice location:
  • Phone: 240-271-7260
  • Fax:
Mailing address:
  • Phone: 240-786-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP0067326
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: