Healthcare Provider Details

I. General information

NPI: 1861633802
Provider Name (Legal Business Name): SUSHMA AMARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5236 W UNIVERSITY DR STE 3800
MCKINNEY TX
75071-8124
US

IV. Provider business mailing address

1110 112TH AVE NE STE 100
BELLEVUE WA
98004-4509
US

V. Phone/Fax

Practice location:
  • Phone: 469-219-3476
  • Fax:
Mailing address:
  • Phone: 425-749-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberS5198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: