Provider Demographics
NPI:1407839368
Name:MUSUNURI, SAILAJA (MD)
Entity Type:Individual
Prefix:
First Name:SAILAJA
Middle Name:
Last Name:MUSUNURI
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 1:527 DUBLIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:484-432-1857
Mailing Address - Fax:610-594-2561
Practice Address - Street 1:8TH AVENUE & HAY RD
Practice Address - Street 2:KIDSPEACE NATIONAL CENTERS BERKS CAMPUS
Practice Address - City:TEMPLE
Practice Address - State:PA
Practice Address - Zip Code:19560
Practice Address - Country:US
Practice Address - Phone:610-929-4670
Practice Address - Fax:610-929-4686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072136L2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018857210004Medicaid
PA0018857210004Medicaid
PA055238Medicare ID - Type Unspecified