MEDICARE: DR. SUKANYA NANDAKUMAR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	42163	TX

General Provider Information

NPI Number	:	1861351942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUKANYA NANDAKUMAR DDS

Provider Business Mailing Address
First Line	:	9524 PEAT CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5973
Country	:	US
Telephone Number	:	224-323-3046
Fax Number	:

Provider Business Practice Location Address
First Line	:	9524 PEAT CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5973
Country	:	US
Telephone Number	:	224-323-3046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/21/2026

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