MEDICARE: SUNDARA J DEVARAJ

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	363LF0000X	Family Nurse Practitioner	NP0067326	DC

General Provider Information

NPI Number	:	1932913357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNDARA J DEVARAJ

Provider Business Mailing Address
First Line	:	14304 DAWN WHISTLE WAY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721
Country	:	US
Telephone Number	:	240-786-2981
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 SARANAC ST
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-2167
Country	:	US
Telephone Number	:	240-271-7260
Fax Number	:

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

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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