Healthcare Provider Details

I. General information

NPI: 1215038435
Provider Name (Legal Business Name): KAMESWARI AMARAVADI M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22217 BRADDOCK AVE
QUEENS VILLAGE NY
11428-1409
US

IV. Provider business mailing address

5025 186TH ST
FRESH MEADOWS NY
11365-1610
US

V. Phone/Fax

Practice location:
  • Phone: 718-217-1930
  • Fax: 718-217-1846
Mailing address:
  • Phone: 718-217-1930
  • Fax: 718-217-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number191527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: