Active NPI
Sunita Jandyam, DMD
- Dentist
- Worcester, MA
National Provider Identifier
1598979833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19957
- Practice address
- 431 Park Ave # B
Worcester, MA 01610-1335 - Phone
- (508) 799-4555
- NPI assigned
- May 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19957 | MA | Primary |
Addresses
Primary practice location
431 Park Ave # B
Worcester, MA 01610-1335
Mailing address
11 Shannon Dr
Shrewsbury, MA 01545-4464
Phone (508) 754-9528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0203611 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19957 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598979833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 SHANNON DR",
"city": "SHREWSBURY",
"state": "MA",
"postal_code": "015454464",
"telephone_number": "508-754-9528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "431 PARK AVE # B",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016101335",
"telephone_number": "508-799-4555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANDYAM",
"first_name": "SUNITA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "19957",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0203611",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.