Provider Demographics
NPI:1447442983
Name:SAJEEVAN, SUJATHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:
Last Name:SAJEEVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:519 KEISLER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7098
Mailing Address - Country:US
Mailing Address - Phone:919-233-8183
Mailing Address - Fax:919-400-4365
Practice Address - Street 1:519 KEISLER DR STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7098
Practice Address - Country:US
Practice Address - Phone:919-233-8183
Practice Address - Fax:919-400-4365
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC01871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914227Medicaid
NCNC6160BMedicare PIN