Provider Demographics
NPI:1922868702
Name:GANGIDI, SUMA (BS)
Entity Type:Individual
Prefix:
First Name:SUMA
Middle Name:
Last Name:GANGIDI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:SUMAVARSHINI
Other - Middle Name:
Other - Last Name:GANGIDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:943 MACOMBER DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1910
Mailing Address - Country:US
Mailing Address - Phone:904-377-1976
Mailing Address - Fax:
Practice Address - Street 1:943 MACOMBER DR
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-1910
Practice Address - Country:US
Practice Address - Phone:904-377-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program