Provider Demographics
NPI:1649790486
Name:ABBAS, SUNDAS (MD)
Entity type:Individual
Prefix:MS
First Name:SUNDAS
Middle Name:
Last Name:ABBAS
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 1:6340 CLAYTON ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-768-8778
Mailing Address - Fax:
Practice Address - Street 1:6340 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-2506
Practice Address - Country:US
Practice Address - Phone:314-768-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-07-29
Deactivation Date:2018-01-26
Deactivation Code:
Reactivation Date:2018-02-21
Provider Licenses
StateLicense IDTaxonomies
KS04-43469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine