Healthcare Provider Details

I. General information

NPI: 1215434295
Provider Name (Legal Business Name): SUNEAL GOPAL PEDDADA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 RAFAEL RIVERA WAY STE 210
LAS VEGAS NV
89113-5395
US

IV. Provider business mailing address

PO BOX 840857
DALLAS TX
75284-0857
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-0070
  • Fax: 702-805-0307
Mailing address:
  • Phone: 702-878-0070
  • Fax: 702-805-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberDO3302
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO3302
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: