Provider Demographics
NPI:1437389277
Name:SUGIANTO, JESSICA ZARAH (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ZARAH
Last Name:SUGIANTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1790 N STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7437
Mailing Address - Country:US
Mailing Address - Phone:972-390-9002
Mailing Address - Fax:214-491-3777
Practice Address - Street 1:5213 VIRGINIA PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5655
Practice Address - Country:US
Practice Address - Phone:972-390-9002
Practice Address - Fax:972-767-4363
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ5932207ZP0102X, 207ZD0900X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology