Provider Demographics
NPI:1003665464
Name:NEDIYIRIPPIL UNNIKRISHNAN, SUMEDHA (MD)
Entity type:Individual
Prefix:
First Name:SUMEDHA
Middle Name:
Last Name:NEDIYIRIPPIL UNNIKRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMEDHA
Other - Middle Name:
Other - Last Name:NEDIYIRIPPIL UNNIKRISHNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1325 NORTHWESTERN DRIVE
Mailing Address - Street 2:APARTMENT 6207
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912
Mailing Address - Country:US
Mailing Address - Phone:915-242-5780
Mailing Address - Fax:915-215-8671
Practice Address - Street 1:2000B TRANSMOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911
Practice Address - Country:US
Practice Address - Phone:915-215-5730
Practice Address - Fax:915-215-8671
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXBP10090582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program