Provider Demographics
NPI:1477552511
Name:CHERUKURI, SUNANDA (MD)
Entity Type:Individual
Prefix:
First Name:SUNANDA
Middle Name:
Last Name:CHERUKURI
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 1:3900 W.15TH STREET
Mailing Address - Street 2:SUITE #205
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:214-473-3283
Mailing Address - Fax:
Practice Address - Street 1:3900 W.15T STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4725
Practice Address - Country:US
Practice Address - Phone:214-473-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1502338Medicaid
TX150233804Medicaid
TX8AS600OtherBCBS
TX1502338Medicaid
TX8F5099Medicare PIN
TX150233804Medicaid