Provider Demographics
NPI:1578043329
Name:NAMBIAR, SUNITHA (MS,CCC,SLP)
Entity Type:Individual
Prefix:
First Name:SUNITHA
Middle Name:
Last Name:NAMBIAR
Suffix:
Gender:F
Credentials:MS,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 OAK VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7220
Mailing Address - Country:US
Mailing Address - Phone:248-917-5160
Mailing Address - Fax:
Practice Address - Street 1:3443 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4411
Practice Address - Country:US
Practice Address - Phone:469-586-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist