Sujata Kunwar Malla, CRNP-PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R251222 Issued in MD

Practice address

1104 Healthway Dr
Salisbury, MD 21804-4469

Phone

(410) 219-5483

Fax

(410) 219-5486

NPI assigned

Feb 12, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Sujata Kunwar Former name

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Three Lower Counties Community Services IncGroup PAC ID 3678484300, 74 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sujata.malla.1@3167.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Three Lower Counties Community Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Princess Anne, MD
  • NPI 1154354744
  Medicare reassignment Care Compare group NPD
• Three Lower Counties Community Services Inc

  • Community/Retail Pharmacy
  • Salisbury, MD
  • NPI 1194768473
  NPD
• Three Lower Counties Community Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Salisbury, MD
  • NPI 1275405714
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1487418141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 HEALTHWAY DR",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218044469",
            "telephone_number": "410-219-5483",
            "fax_number": "410-219-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLA",
        "first_name": "SUJATA",
        "middle_name": "KUNWAR",
        "name_prefix": "Ms.",
        "credential": "CRNP-PMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R251222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUJATA",
            "last_name": "KUNWAR",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chiranjibi Mainali, MBBCH
• Melvin Makey, DNP, CRNA
• Raymond T Makowske
• Mahmoud Malayeri, MD
• Sufyan Mustafa Malik, M.D.
• Andrea D Maloney, RN, CCM
• Avital Maltinski
• Gul Ghutai Manalai, M.D
• Kush Mangal, DMD
• Barbara Louise Manry, CRNP

• Psychiatric/Mental Health Nurse Practitioner in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.