Provider Demographics
NPI:1346534302
Name:MALLA, SUNITHA (MD)
Entity Type:Individual
Prefix:
First Name:SUNITHA
Middle Name:
Last Name:MALLA
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 1:7601 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8331
Mailing Address - Country:US
Mailing Address - Phone:817-274-2578
Mailing Address - Fax:817-595-2096
Practice Address - Street 1:7601 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8331
Practice Address - Country:US
Practice Address - Phone:817-274-2578
Practice Address - Fax:817-595-2096
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8501207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284574501Medicaid
P8501OtherTEXAS LICENSE
TX284574501Medicaid