Healthcare Provider Details

I. General information

NPI: 1376564021
Provider Name (Legal Business Name): DEV ANAND MANISUNDARAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N FLOWOOD DR STE A
FLOWOOD MS
39232-9532
US

IV. Provider business mailing address

1030 N FLOWOOD DR STE A
FLOWOOD MS
39232-9532
US

V. Phone/Fax

Practice location:
  • Phone: 601-387-9005
  • Fax: 601-387-9006
Mailing address:
  • Phone: 601-387-9005
  • Fax: 601-387-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number13503
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number13503
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: