Healthcare Provider Details

I. General information

NPI: 1558430645
Provider Name (Legal Business Name): SUJANI VARMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUJANI RAJU

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 STURBRIDGE LN
DIX HILLS NY
11746-5015
US

IV. Provider business mailing address

14 STURBRIDGE LN
DIX HILLS NY
11746-5015
US

V. Phone/Fax

Practice location:
  • Phone: 516-728-4603
  • Fax:
Mailing address:
  • Phone: 516-728-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number241749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: