Provider Demographics
NPI:1164471033
Name:RAVELLA, SUNANDA (MD)
Entity Type:Individual
Prefix:
First Name:SUNANDA
Middle Name:
Last Name:RAVELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4753 N ELSTON AVE
Mailing Address - Street 2:MAYFAIR HEALTHCARE CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4002
Mailing Address - Country:US
Mailing Address - Phone:773-205-7200
Mailing Address - Fax:773-481-7577
Practice Address - Street 1:4753 N ELSTON AVE
Practice Address - Street 2:MAYFAIR HEALTHCARE CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4002
Practice Address - Country:US
Practice Address - Phone:773-205-7200
Practice Address - Fax:773-481-7577
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC95830Medicare UPIN