Healthcare Provider Details

I. General information

NPI: 1528645058
Provider Name (Legal Business Name): DEON GUDURU DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

2509 BRIGGS CHANEY RD
SILVER SPRING MD
20905-4506
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2000
  • Fax:
Mailing address:
  • Phone: 301-922-9315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number692264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: