Provider Demographics
NPI:1801844782
Name:SAJJA, PRASUNA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASUNA
Middle Name:
Last Name:SAJJA
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 1:28419 TANNER CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1977
Mailing Address - Country:US
Mailing Address - Phone:713-385-5642
Mailing Address - Fax:
Practice Address - Street 1:28419 TANNER CROSSING LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1977
Practice Address - Country:US
Practice Address - Phone:713-385-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179345701Medicaid
TX8F2489Medicare PIN
TX179345701Medicaid