Healthcare Provider Details

I. General information

NPI: 1831015676
Provider Name (Legal Business Name): SUNIL KUMAR YADAV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAINT PAULS PL
GREAT NECK NY
11021-2636
US

IV. Provider business mailing address

3746 77TH ST APT 1F
JACKSON HEIGHTS NY
11372-6600
US

V. Phone/Fax

Practice location:
  • Phone: 516-862-1202
  • Fax: 516-758-1278
Mailing address:
  • Phone: 214-609-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP131025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: