Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 35284 | CO |
NPI | 1174603005 |
---|---|
Provider Name | Ashakiran J Sunku |
First Address | Pueblo, CO 81003-2700 |
Second Address | Pueblo, CO 81003-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F45443 | (02) | CO |