Provider Demographics
NPI:1518939214
Name:VALAVALKAR, SUSHIL SADANAND (MD)
Entity Type:Individual
Prefix:
First Name:SUSHIL
Middle Name:SADANAND
Last Name:VALAVALKAR
Suffix:
Gender:M
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 40159
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-871-4409
Mailing Address - Fax:210-524-9599
Practice Address - Street 1:7700 FLOYD CURL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-871-4409
Practice Address - Fax:210-524-9599
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36421208000000X
TXM9068208000000X
FLME99888208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936304Medicaid
TX220206101Medicaid
KY64033608Medicaid
KY64033608Medicaid