Provider Demographics
NPI:1083878078
Name:VENKATACHALAM, SUKANYA PILLAI (MD)
Entity Type:Individual
Prefix:
First Name:SUKANYA PILLAI
Middle Name:
Last Name:VENKATACHALAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUKANYA PILLAI
Other - Middle Name:
Other - Last Name:VENKATACHALAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5924 STONERIDGE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2887
Mailing Address - Country:US
Mailing Address - Phone:925-944-1733
Mailing Address - Fax:925-223-6625
Practice Address - Street 1:5924 STONERIDGE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2887
Practice Address - Country:US
Practice Address - Phone:925-944-1733
Practice Address - Fax:925-223-6625
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250538562084P0800X
CAA1126952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK971ZMedicare PIN