Provider Demographics
NPI:1891074167
Name:SUMAN, NISHA (MD)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:SUMAN
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 1:2505 MERCED ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1811
Mailing Address - Country:US
Mailing Address - Phone:800-300-6664
Mailing Address - Fax:661-237-6889
Practice Address - Street 1:2505 MERCED ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721
Practice Address - Country:US
Practice Address - Phone:800-300-6664
Practice Address - Fax:661-237-6889
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128930208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics