Provider Demographics
NPI:1730576547
Name:SWIFT, SUNTARA
Entity type:Individual
Prefix:
First Name:SUNTARA
Middle Name:
Last Name:SWIFT
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 1:2531 PIONEER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2071
Mailing Address - Country:US
Mailing Address - Phone:678-779-1255
Mailing Address - Fax:
Practice Address - Street 1:2531 PIONEER OAKS DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-2071
Practice Address - Country:US
Practice Address - Phone:678-779-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program