Provider Demographics
NPI:1689667032
Name:GUNNALA, SUJATHA (MD)
Entity Type:Individual
Prefix:
First Name:SUJATHA
Middle Name:
Last Name:GUNNALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 N 32ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6281
Mailing Address - Country:US
Mailing Address - Phone:602-956-7481
Mailing Address - Fax:602-956-7591
Practice Address - Street 1:3125 N 32ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6281
Practice Address - Country:US
Practice Address - Phone:602-956-7481
Practice Address - Fax:602-956-7591
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-09
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
AZ11933207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD44004Medicare UPIN