Provider Demographics
NPI:1437197043
Name:UPPAL, SUKHDEV (PA-C)
Entity Type:Individual
Prefix:
First Name:SUKHDEV
Middle Name:
Last Name:UPPAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 E WASHINGTON AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5793
Mailing Address - Country:US
Mailing Address - Phone:702-796-8500
Mailing Address - Fax:702-796-8502
Practice Address - Street 1:3201 S MARYLAND PKWY
Practice Address - Street 2:STE 314
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2441
Practice Address - Country:US
Practice Address - Phone:702-796-8500
Practice Address - Fax:702-796-8502
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503813Medicaid
NV100161Medicare ID - Type Unspecified