Healthcare Provider Details

I. General information

NPI: 1942007588
Provider Name (Legal Business Name): SUDHA RANI KAILAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 GRANT AVE STE C
SANTA FE NM
87501-1687
US

IV. Provider business mailing address

743 W MANHATTAN AVE APT B
SANTA FE NM
87501-3792
US

V. Phone/Fax

Practice location:
  • Phone: 505-428-9504
  • Fax:
Mailing address:
  • Phone: 505-428-9504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUDHA KAILAS
Title or Position: OWNER
Credential: MD, PHD
Phone: 505-428-9504