Healthcare Provider Details

I. General information

NPI: 1720609076
Provider Name (Legal Business Name): SUNNY KAMLESH BRAHMBHATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 E HUNDRED RD
CHESTER VA
23836-2613
US

IV. Provider business mailing address

PO BOX 639970
CINCINNATI OH
45263-9970
US

V. Phone/Fax

Practice location:
  • Phone: 804-796-2373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0101283338
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: