Healthcare Provider Details

I. General information

NPI: 1275112229
Provider Name (Legal Business Name): SUCHAKREE SANGUANSATAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12850 DALLAS PKWY STE 200
FRISCO TX
75033-0844
US

IV. Provider business mailing address

12850 DALLAS PKWY STE 200
FRISCO TX
75033-0844
US

V. Phone/Fax

Practice location:
  • Phone: 469-678-7802
  • Fax: 833-972-5253
Mailing address:
  • Phone: 617-636-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1019528
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number289072
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: