Provider Demographics
NPI:1962841841
Name:PATIBANDA, SUGUNA (MD)
Entity Type:Individual
Prefix:
First Name:SUGUNA
Middle Name:
Last Name:PATIBANDA
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 1:2719 PICKERING RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3636
Mailing Address - Country:US
Mailing Address - Phone:302-453-1550
Mailing Address - Fax:
Practice Address - Street 1:2719 PICKERING RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3636
Practice Address - Country:US
Practice Address - Phone:302-453-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-000898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics