Healthcare Provider Details

I. General information

NPI: 1851788954
Provider Name (Legal Business Name): SIVAVEERA KANDASAMY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD HEALTH SCIENCES CENTER T19-080
STONY BROOK NY
11794-8191
US

IV. Provider business mailing address

101 NICOLLS RD HEALTH SCIENCES CENTER T19-080
STONY BROOK NY
11794-8191
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1820
  • Fax: 631-444-8963
Mailing address:
  • Phone: 631-444-1820
  • Fax: 631-444-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number337803
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD0093659
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number337803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: