Healthcare Provider Details

I. General information

NPI: 1376534651
Provider Name (Legal Business Name): SUDHA AYYALA ANUPINDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA - RADIOLOGY
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA - RADIOLOGY
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7000
  • Fax: 215-590-9348
Mailing address:
  • Phone: 215-590-7000
  • Fax: 215-590-9348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD429735
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD429735
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD429735
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: