Healthcare Provider Details

I. General information

NPI: 1295945897
Provider Name (Legal Business Name): SUDHA RANI KAILAS MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
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

413 GRANT AVE STE C
SANTA FE NM
87501-1687
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 TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD2012-0061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: