Provider Demographics
NPI:1689161101
Name:WEBER, SUNAYANA (IBCLC)
Entity Type:Individual
Prefix:
First Name:SUNAYANA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:NAYA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:11105 MAELIN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2052
Mailing Address - Country:US
Mailing Address - Phone:570-977-0366
Mailing Address - Fax:
Practice Address - Street 1:11105 MAELIN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2052
Practice Address - Country:US
Practice Address - Phone:570-977-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-136055174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-136055OtherIBLCE