Provider Demographics
NPI:1174973028
Name:SUNDAR, PREEYANKA RUBIANA
Entity type:Individual
Prefix:
First Name:PREEYANKA
Middle Name:RUBIANA
Last Name:SUNDAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JILLIAN DR
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1203
Mailing Address - Country:US
Mailing Address - Phone:774-627-5766
Mailing Address - Fax:
Practice Address - Street 1:615 MICHAEL ST NE STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-3767
Practice Address - Country:US
Practice Address - Phone:404-727-5596
Practice Address - Fax:404-727-5767
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268301207R00000X
GA90255207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine