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General NPI Number Information
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NPI Number | 1679913545
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Entity Type | Individual
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Provider Name | VIJI SUNDARAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 836 PRUDENTIAL DR STE 902
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8336
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Country | US
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Telephone | 904-399-5620
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Fax |
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Provider Business Mailing Address
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Address Line | 836 PRUDENTIAL DR STE 902
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8336
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Country | US
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Telephone | 415-535-2494
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Fax |
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | ME162700
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 147967
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 006126
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License Number State | GA
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