Healthcare Provider Details

I. General information

NPI: 1851455752
Provider Name (Legal Business Name): SUDHA RAO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 ESAT 149TH STREET DEPARTMENT OF PEDIATRIC ROOM 420
BRONX NY
10451
US

IV. Provider business mailing address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5360
  • Fax: 718-579-4958
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-945-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1318641
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: