Provider Demographics
NPI:1649752882
Name:CHIRAYATH, SUMA STANLY
Entity Type:Individual
Prefix:
First Name:SUMA
Middle Name:STANLY
Last Name:CHIRAYATH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SUMA
Other - Middle Name:STANLY
Other - Last Name:CHIRAYATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:413 ANNA AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5842
Mailing Address - Country:US
Mailing Address - Phone:978-729-0920
Mailing Address - Fax:
Practice Address - Street 1:4343 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4603
Practice Address - Country:US
Practice Address - Phone:972-394-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty