Provider Demographics
NPI:1598906075
Name:VARUGHESE, SUNITHA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUNITHA
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SUNITHA
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19821 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4954
Mailing Address - Country:US
Mailing Address - Phone:586-412-8046
Mailing Address - Fax:
Practice Address - Street 1:19821 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4954
Practice Address - Country:US
Practice Address - Phone:586-412-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant