Basic Information
Provider Information | |||||||||
NPI: | 1609118827 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SUNIL | ||||||||
FirstName: | PRAHLAD | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 350 7TH ST N | ||||||||
Address2: |   | ||||||||
City: | NAPLES | ||||||||
State: | FL | ||||||||
PostalCode: | 341025754 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2396243997 | ||||||||
FaxNumber: | 2396248101 | ||||||||
Practice Location | |||||||||
Address1: | 350 7TH ST N | ||||||||
Address2: |   | ||||||||
City: | NAPLES | ||||||||
State: | FL | ||||||||
PostalCode: | 341025754 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2396243997 | ||||||||
FaxNumber: | 2396248101 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/26/2013 | ||||||||
LastUpdateDate: | 11/07/2018 | ||||||||
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 | 207R00000X | ME127822 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | ME127822 | FL | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | M0KQ0 | 01 | FL | BCBS | OTHER | 017250100 | 05 | FL |   | MEDICAID | ME127822 | 01 | FL | MEDICAL LICENSE | OTHER | IO479Z | 01 | FL | MEDICARE | OTHER |