Provider Demographics
NPI:1841288495
Name:SUNKAVALLI, PAUL V (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:V
Last Name:SUNKAVALLI
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ROUTE 72 W STE 304
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2475
Mailing Address - Country:US
Mailing Address - Phone:609-978-3910
Mailing Address - Fax:609-978-3912
Practice Address - Street 1:1100 ROUTE 72 W STE 304
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2475
Practice Address - Country:US
Practice Address - Phone:609-978-3910
Practice Address - Fax:609-978-3912
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07784500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0067016Medicaid
NJ092062UBGMedicare ID - Type Unspecified
NJ0067016Medicaid