Healthcare Provider Details

I. General information

NPI: 1689257826
Provider Name (Legal Business Name): NIVEDHA ARUMUGAM SUKUMAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIVI SUKUMAR DO

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

7601 PRESTON RD
PLANO TX
75024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 972-672-2824
  • Fax: 713-500-5800
Mailing address:
  • Phone: 214-456-9250
  • Fax: 214-456-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV0557
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: