MEDICARE: MR. SUDARSHAN MULLAPUDI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	19.001186	CT

General Provider Information

NPI Number	:	1235871179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUDARSHAN MULLAPUDI

Provider Business Mailing Address
First Line	:	83 WASHINGTON AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-1704
Country	:	US
Telephone Number	:	203-787-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 WASHINGTON AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-1704
Country	:	US
Telephone Number	:	203-787-3800
Fax Number	:	203-787-3800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	01/27/2026

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