Provider Demographics
NPI:1669774634
Name:SATYAVADA, SUNDERRAM V (CRT, RCP)
Entity type:Individual
Prefix:MR
First Name:SUNDERRAM
Middle Name:V
Last Name:SATYAVADA
Suffix:
Gender:M
Credentials:CRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3402 N BIG SPRING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5503
Mailing Address - Country:US
Mailing Address - Phone:432-683-1199
Mailing Address - Fax:432-683-1105
Practice Address - Street 1:3402 N BIG SPRING ST
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5503
Practice Address - Country:US
Practice Address - Phone:432-683-1199
Practice Address - Fax:432-683-1105
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57471332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies