Basic Information
| Provider Information | |||||||||
| NPI: | 1356724553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UPADHAYA | ||||||||
| FirstName: | SUNIL | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 STANTONSBURG RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278342818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528474810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 ACADEMY ST S | ||||||||
| Address2: | |||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279103248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522093000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301107723 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.