MEDICARE: DR. KAMALA SUNDARI ADURY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	35.092415	OH
2	2084P0800X	Psychiatry Physician	35.092415	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619142387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMALA SUNDARI ADURY M.D.

Provider Business Mailing Address
First Line	:	3364 PRAIRIE VISTA CT
Second Line	:
City	:	RICHFIELD
State	:	OH
Zip	:	44286-9079
Country	:	US
Telephone Number	:	234-564-6646
Fax Number	:	234-517-6646

Provider Business Practice Location Address
First Line	:	805 E WASHINGTON ST STE 200
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3331
Country	:	US
Telephone Number	:	234-564-6646
Fax Number	:	234-517-6646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	11/22/2021

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