Provider Demographics
NPI:1265420723
Name:SUNDAR, KALPANA (DO)
Entity type:Individual
Prefix:
First Name:KALPANA
Middle Name:
Last Name:SUNDAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KALPANA
Other - Middle Name:SUNDAR
Other - Last Name:DEPASQUALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:871 VILLAGE BLVD SUITE 603
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-725-8399
Mailing Address - Fax:
Practice Address - Street 1:871 VILLAGE BLVD SUITE 603
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-725-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8839207YS0123X
FL058839207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267562500Medicaid
FL71606AMedicare PIN
FL267562500Medicaid