Provider Demographics
NPI:1174567655
Name:NAYAK, SUNDEEP M (MD)
Entity type:Individual
Prefix:
First Name:SUNDEEP
Middle Name:M
Last Name:NAYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MERCED ST
Mailing Address - Street 2:STE 1649
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 MERCED ST
Practice Address - Street 2:STE 1649
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-784-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA668732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A6687312Medicare PIN
CA00A668735Medicare PIN
CA300125548Medicare PIN
CA00A6687314Medicare PIN
CA00A6687317Medicare PIN
CA00A668731Medicare PIN
CA00A6687316Medicare PIN
CA00A6687318Medicare PIN
CA00A6687319Medicare PIN
CA00A6687321Medicare PIN
CA00A6687310Medicare PIN
CA00A668734Medicare PIN
CA00A668739Medicare PIN
CA300125556Medicare PIN
CAG85876Medicare UPIN
CA00A6687320Medicare PIN
CA00A668733Medicare PIN
CA00A6687315Medicare PIN
CA00A668732Medicare PIN
CA00A668736Medicare PIN
CA300125557Medicare PIN
CA00A6687311Medicare PIN
CA00A6687313Medicare PIN
CA00A668737Medicare PIN
CA00A668738Medicare PIN