Provider Demographics
NPI:1689666356
Name:SUNKAVALLI, KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:SUNKAVALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14422
Mailing Address - Street 2:KRISHNA SUNKAVALLI
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4037
Mailing Address - Country:US
Mailing Address - Phone:325-576-3611
Mailing Address - Fax:325-576-3854
Practice Address - Street 1:350 NW AVENUE F
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:TX
Practice Address - Zip Code:79520-3016
Practice Address - Country:US
Practice Address - Phone:325-576-3611
Practice Address - Fax:325-576-3854
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1395006-08Medicaid
B26779Medicare UPIN
TX00TX28Medicare PIN