Healthcare Provider Details

I. General information

NPI: 1295761542
Provider Name (Legal Business Name): AJAY SUMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E REED ST
HAYTI MO
63851-1242
US

IV. Provider business mailing address

90 ALTON RD APT 409
MIAMI BEACH FL
33139-6878
US

V. Phone/Fax

Practice location:
  • Phone: 786-774-7143
  • Fax:
Mailing address:
  • Phone: 786-774-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number272949
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2018033164
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberC168990
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number56900
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN6697
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberME147986
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberN6697
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: