Provider Demographics
NPI:1376864017
Name:SULAI, NANNA HELEN (MD)
Entity Type:Individual
Prefix:
First Name:NANNA
Middle Name:HELEN
Last Name:SULAI
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1242
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:910 E HOUSTON ST STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8363
Practice Address - Country:US
Practice Address - Phone:903-579-9800
Practice Address - Fax:903-526-4463
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01414207R00000X, 207RH0000X, 207RH0003X, 207RX0202X
TXT1574207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2840Medicaid
NC1376864017Medicaid
MN110014848Medicare PIN
NCNCT602AMedicare PIN