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General NPI Number Information
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NPI Number | 1275988933
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Entity Type | Individual
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Provider Name | SUNIL KUMAR JEGANATHAN MD, DPM
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Gender | Male
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 111 VISION PARK BLVD STE 240
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City | SHENANDOAH
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State | TX
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Zip | 77384-3004
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Country | US
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Telephone | 936-273-6000
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Fax | 936-273-6022
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Provider Business Mailing Address
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Address Line | 111 VISION PARK BLVD STE 240
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City | SHENANDOAH
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State | TX
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Zip | 77384-3004
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Country | US
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Telephone | 936-273-6000
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Fax | 936-273-6022
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2385
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 2385
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License Number State | TX
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