Basic Information
Provider Information | |||||||||
NPI: | 1134504723 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ABRAHAM | ||||||||
FirstName: | SUNIJ | ||||||||
MiddleName: | MATHEW | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | N/A | ||||||||
OtherFirstName: | N/A | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | FNP-C | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 650859 | ||||||||
Address2: | DEPT 710 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752650859 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4097722222 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 301 UNIVERSITY BLVD | ||||||||
Address2: | UTMB FAMILY MEDICINE CBC | ||||||||
City: | GALVESTON | ||||||||
State: | TX | ||||||||
PostalCode: | 77550 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4097722222 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/23/2015 | ||||||||
LastUpdateDate: | 09/20/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP128603 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.