Provider Demographics
NPI:1265607758
Name:SUNDARESAN, AGNES SWEETLIN HEPSIBAH (MD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:SWEETLIN HEPSIBAH
Last Name:SUNDARESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AGNES
Other - Middle Name:SWEETLIN HEPSIBAH
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:16 WOODBINE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-8029
Practice Address - Country:US
Practice Address - Phone:570-271-6070
Practice Address - Fax:570-271-5609
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 193118207R00000X, 208000000X
PAMD445175208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine