Healthcare Provider Details

I. General information

NPI: 1396221750
Provider Name (Legal Business Name): SUMEDHA PURKAYASTHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 09/29/2026
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

57 W 57TH ST STE 507
NEW YORK NY
10019-2826
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-4000
  • Fax:
Mailing address:
  • Phone: 212-337-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number327931
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number327931
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1012954
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number327931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: