Healthcare Provider Details

I. General information

NPI: 1023098308
Provider Name (Legal Business Name): SUDHA M RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE KINGS COUNTY HOSPITAL CENTER
BROOKLYN NY
11203
US

IV. Provider business mailing address

451 CLARKSON AVE C5203 KINGS COUNTY HOSPITAL CENTER
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3325
  • Fax: 718-245-4107
Mailing address:
  • Phone: 718-245-4560
  • Fax: 718-245-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1649061
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number1649061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: