Provider Demographics
NPI:1073807509
Name:JOLLY, SUNEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNEIL
Middle Name:
Last Name:JOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2706 HESSMER AVE
Mailing Address - Street 2:STE A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7046
Mailing Address - Country:US
Mailing Address - Phone:504-754-2334
Mailing Address - Fax:504-324-2078
Practice Address - Street 1:231 W ESPLANADE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2509
Practice Address - Country:US
Practice Address - Phone:504-754-2334
Practice Address - Fax:504-324-2078
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.301574208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2425731Medicaid
LA503434YJM6Medicare PIN