Provider Demographics
NPI:1952362980
Name:PUDHOTA, SUNITHA GUDAPATI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNITHA
Middle Name:GUDAPATI
Last Name:PUDHOTA
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 1:309 REGENCY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5165
Mailing Address - Country:US
Mailing Address - Phone:682-400-2153
Mailing Address - Fax:972-572-2228
Practice Address - Street 1:309 REGENCY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5165
Practice Address - Country:US
Practice Address - Phone:682-400-2153
Practice Address - Fax:972-572-2228
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94091207R00000X
LAMD203357207RG0100X
TXP1484207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288404101Medicaid
TX8DC048OtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TX8DC048OtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TXTXB144425Medicare PIN