Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R-9294 | IA |
N | 111NI0900X | Internist | R-9294 | IA |
N | 2084N0400X | Neurologist | MD170301 | OR |
Y | 2084N0400X | Neurologist | T2672 | TX |
NPI | 1043508070 |
---|---|
Provider Name | Dr. Sulagshan Mahendrarajah |
First Address | Kyle, TX 78640-2692 |
Second Address | Medford, OR 97504-4334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 05/01/2022 |