Provider Demographics
NPI:1851427140
Name:PERSAUD, SUNIL TERRY (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:TERRY
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 KILARNEY CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-0815
Mailing Address - Country:US
Mailing Address - Phone:229-293-9555
Mailing Address - Fax:229-293-9557
Practice Address - Street 1:2406 BEMISS RD
Practice Address - Street 2:SUITE C
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1997
Practice Address - Country:US
Practice Address - Phone:229-293-9555
Practice Address - Fax:229-293-9557
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048175207LP2900X
FLME0061636207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00891404AMedicaid
GA05BDHKLMedicare ID - Type Unspecified
GA00891404AMedicaid