Provider Demographics
NPI:1023095809
Name:PANDITA, SUNNY (MD)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:PANDITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 S. FASHION BLVD.
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-260-5864
Mailing Address - Fax:801-260-5865
Practice Address - Street 1:5801 S. FASHION BLVD.
Practice Address - Street 2:SUITE 280
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-260-5864
Practice Address - Fax:801-260-5865
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
UT5086790-1205174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH56460Medicare UPIN
UTHH56460Medicare UPIN
UT004622024Medicare PIN