1780962431 NPI number — DR. SUNITHA SURESH MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780962431 NPI number — DR. SUNITHA SURESH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SURESH
Provider First Name:
SUNITHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SURESH
Provider Other First Name:
SUNITHA
Provider Other Middle Name:
DESIKAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780962431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LOCKBOX DEPT 880778
Provider Second Line Business Mailing Address:
PO BOX 29650
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85038-9650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-572-1826
Provider Business Mailing Address Fax Number:
623-552-3320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 S DOBSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85202-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-412-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD60226533 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: MD 60226533 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 31640 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1780962431 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 797194 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0287422 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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