Provider Demographics
NPI:1356411102
Name:SUNDARA-RAJAN, THIRUMALAI (PA)
Entity type:Individual
Prefix:
First Name:THIRUMALAI
Middle Name:
Last Name:SUNDARA-RAJAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22175 RYE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3037
Mailing Address - Country:US
Mailing Address - Phone:216-295-0047
Mailing Address - Fax:
Practice Address - Street 1:22175 RYE RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-3037
Practice Address - Country:US
Practice Address - Phone:216-295-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P88271Medicare UPIN