Healthcare Provider Details

I. General information

NPI: 1023462538
Provider Name (Legal Business Name): SINDHURI GAYAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 ONONDAGA BLVD
SYRACUSE NY
13219-3114
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2866
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5784
  • Fax: 315-492-5782
Mailing address:
  • Phone: 315-937-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number299744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: