Provider Demographics
NPI:1851480040
Name:IYER, SUJATA PRASHANT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:PRASHANT
Last Name:IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUJATA
Other - Middle Name:LAKSHMANAN
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1530 E CHEVY CHASE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4139
Mailing Address - Country:US
Mailing Address - Phone:818-246-7260
Mailing Address - Fax:
Practice Address - Street 1:1530 E CHEVY CHASE DR STE 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4139
Practice Address - Country:US
Practice Address - Phone:818-246-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51957208000000X
WAMD00037524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics