Healthcare Provider Details

I. General information

NPI: 1073535043
Provider Name (Legal Business Name): SUDHANSHU NARENDRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10314 LEFFERTS BLVD
JAMAICA NY
11419-2012
US

IV. Provider business mailing address

10314 LEFFERTS BLVD
JAMAICA NY
11419-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-843-2244
  • Fax:
Mailing address:
  • Phone: 718-843-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number163188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: