Healthcare Provider Details

I. General information

NPI: 1114728292
Provider Name (Legal Business Name): SAI KAUSHIK YETURU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GUSTAVE L. LEVY PLACE DEPARTMENT OF ANESTHESIOLOGY, BOX 1010
NEW YORK NY
10029
US

IV. Provider business mailing address

1132 LASNIK ST
ERIE CO
80516-5428
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-7473
  • Fax:
Mailing address:
  • Phone: 720-431-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: