Healthcare Provider Details

I. General information

NPI: 1407839368
Provider Name (Legal Business Name): SAILAJA MUSUNURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8TH AVENUE & HAY RD KIDSPEACE NATIONAL CENTERS BERKS CAMPUS
TEMPLE PA
19560
US

IV. Provider business mailing address

527 DUBLIN DRIVE
DOWNINGTON PA
19335
US

V. Phone/Fax

Practice location:
  • Phone: 610-929-4670
  • Fax: 610-929-4686
Mailing address:
  • Phone: 484-432-1857
  • Fax: 610-594-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11355800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA11355800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD072136L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: