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General NPI Number Information
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NPI Number | 1356514285
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Entity Type | Organization
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Legal Business Name | SUDHAKAR PERALA RAO
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 725 ORCHARD PARK RD STE F
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City | WEST SENECA
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State | NY
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Zip | 14224-3352
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Country | US
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Telephone | 716-712-0441
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Fax | 716-712-0478
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Provider Business Mailing Address
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Address Line | 725 ORCHARD PARK RD STE F
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City | WEST SENECA
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State | NY
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Zip | 14224-3352
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Country | US
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Telephone | 716-712-0441
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Fax | 716-712-0478
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUDHAKAR RAO
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Credential |
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Telephone | 716-712-0441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 113725
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License Number State | NY
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