Provider Demographics
NPI:1427223155
Name:SUNDARAM-MOHIP, PRETHI (DO)
Entity Type:Individual
Prefix:DR
First Name:PRETHI
Middle Name:
Last Name:SUNDARAM-MOHIP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PRITHI
Other - Middle Name:
Other - Last Name:SUNDARAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:13660 JOG ROAD
Mailing Address - Street 2:S.8
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6157
Mailing Address - Country:US
Mailing Address - Phone:561-637-4040
Mailing Address - Fax:561-637-2698
Practice Address - Street 1:13660 JOG ROAD
Practice Address - Street 2:S.8
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6157
Practice Address - Country:US
Practice Address - Phone:561-637-4040
Practice Address - Fax:561-637-2698
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9927207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology