Provider Demographics
NPI:1255837274
Name:ZACHARIAH, SUMA ASHA
Entity Type:Individual
Prefix:
First Name:SUMA
Middle Name:ASHA
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BROOKWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-2606
Mailing Address - Country:US
Mailing Address - Phone:972-226-9941
Mailing Address - Fax:
Practice Address - Street 1:296 BROOKWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-2606
Practice Address - Country:US
Practice Address - Phone:972-226-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP137122OtherBOARD OF NURSING