Healthcare Provider Details

I. General information

NPI: 1336721935
Provider Name (Legal Business Name): MADHURYA SAI AMIRAPU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E. ADAMS STREET, SYRACUSE, NY 13210
SYRACUSE NY
13210
US

IV. Provider business mailing address

750 E. ADAMS STREET, SYRACUSE, NY 13210
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5240
  • Fax:
Mailing address:
  • Phone: 315-464-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD494192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: