Shiyamali Sundararajan

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

39852 Issued in TX

Practice address

12319 N Mopac Expy Ste 160
Austin, TX 78758-2648

Phone

(512) 222-5721

NPI assigned

Jul 25, 2023

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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Texas Periodontists PC

  • Periodontics
  • Austin, TX
  • NPI 1467132159
  NPD

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1679254544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 CADDO LAKE DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786287137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12319 N MOPAC EXPY STE 160",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582648",
            "telephone_number": "512-222-5721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "529 Caddo Lake Dr",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "TX",
            "postal_code": "786287137",
            "country_code": "US",
            "telephone_number": "510-674-8439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUNDARARAJAN",
        "first_name": "SHIYAMALI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "39852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suncrest Hospice Austin LLC (Suncrest Hospice)
• Sundance Medical Services, Inc
• Sundance Physician Services, Inc
• Megana Sundar, DO
• Varun Sundaram, MD
• Madhu Sundarrajan
• Kristin Elizabeth Sundberg, L.AC., MAOM
• Lisa M Sunden, MSN CNM
• Lillian Sunderman, DC
• Susan Denise Sundin, LPC-S

• Periodontics in Austin, TX
• Providers in Austin, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.