Healthcare Provider Details

I. General information

NPI: 1245618081
Provider Name (Legal Business Name): ANUPAMA SUNDAR MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 EXECUTIVE PL
FAYETTEVILLE NC
28305-5193
US

IV. Provider business mailing address

100 WOODS ROAD SUITE N-314 WESTCHESTER MEDICAL CENTER
VALHALLA NY
10595
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3333
  • Fax:
Mailing address:
  • Phone: 914-493-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2020-02580
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number202002580
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: