Provider Demographics
NPI:1689991564
Name:SUNKIREDDY, NANDINI (MD)
Entity Type:Individual
Prefix:
First Name:NANDINI
Middle Name:
Last Name:SUNKIREDDY
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 1:2500 HOSPITAL BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4946
Mailing Address - Country:US
Mailing Address - Phone:770-740-1753
Mailing Address - Fax:770-740-8503
Practice Address - Street 1:2500 HOSPITAL BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-740-1753
Practice Address - Fax:770-740-8503
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206195207Q00000X
GA76688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA206195OtherMEDICAL LICENSE NUMBER