Healthcare Provider Details

I. General information

NPI: 1770947327
Provider Name (Legal Business Name): SUNAINA SUHAG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11714 WILSON PARKE AVE STE 150
AUSTIN TX
78726-4061
US

IV. Provider business mailing address

6210 E US HWY 290 STE. 420 - CREDENTIALING
AUSTIN TX
78723-1098
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-6611
  • Fax: 512-406-6267
Mailing address:
  • Phone: 512-483-9569
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS1285
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: