Healthcare Provider Details

I. General information

NPI: 1508867086
Provider Name (Legal Business Name): SUJATHA PANDIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-770-9095
  • Fax: 724-770-9096
Mailing address:
  • Phone: 724-770-9095
  • Fax: 724-770-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD420452
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: