Provider Demographics
NPI:1275622821
Name:SUNKAVALLY, SRINIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:
Last Name:SUNKAVALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W PARK
Mailing Address - Street 2:STE 109
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351
Mailing Address - Country:US
Mailing Address - Phone:936-327-5611
Mailing Address - Fax:866-918-3456
Practice Address - Street 1:210 W PARK
Practice Address - Street 2:STE 109
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-327-5611
Practice Address - Fax:866-918-3456
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9683208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000923202OtherBLUE CROSS BLUE SHIELD
IL036111315Medicaid
K50198Medicare PIN
ILI17284Medicare UPIN
TXTXP105398Medicare PIN