Healthcare Provider Details

I. General information

NPI: 1023538865
Provider Name (Legal Business Name): AMANDA I SUKHU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E MAIN ST
RIVERHEAD NY
11901-2613
US

IV. Provider business mailing address

169 PUTNAM HALL BUILDING C
STONY BROOK NY
11794-8515
US

V. Phone/Fax

Practice location:
  • Phone: 631-632-2428
  • Fax:
Mailing address:
  • Phone: 631-632-2428
  • Fax: 814-226-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT017943
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number324130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: