Healthcare Provider Details

I. General information

NPI: 1215324116
Provider Name (Legal Business Name): SANDEEP KUMAR PURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SANDEEP KUMAR

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 CREEKSTONE DR
DURHAM NC
27703-9822
US

IV. Provider business mailing address

PO BOX 110566
DURHAM NC
27709-5566
US

V. Phone/Fax

Practice location:
  • Phone: 919-385-8880
  • Fax:
Mailing address:
  • Phone: 919-620-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number275177
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number2026-00347
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number91546
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number91546
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60486
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: