Healthcare Provider Details

I. General information

NPI: 1689364069
Provider Name (Legal Business Name): MR. SUJITH VASIREDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 02/16/2024
Certification Date: 05/10/2023
Deactivation Date: 12/18/2023
Reactivation Date: 02/16/2024

III. Provider practice location address

450 CLARKSON AVENUE, SUNY DOWNSTATE NEUROLOGY DEPARTMENT
BOOKLYN, NEWYORK NY
11203
US

IV. Provider business mailing address

450 CLARKSON AVE NEUROLOGY DEPARTMENT
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-4232
  • Fax:
Mailing address:
  • Phone: 718-270-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: