MEDICARE: SARITA SUCHDEV FNP

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	163W00000X	Registered Nurse	641075	NY
2	363LF0000X	Family Nurse Practitioner	F342506-1	NY

General Provider Information

NPI Number	:	1760758577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARITA SUCHDEV FNP

Provider Business Mailing Address
First Line	:	25207 82ND DR
Second Line	:
City	:	BELLEROSE
State	:	NY
Zip	:	11426-2508
Country	:	US
Telephone Number	:	718-470-0347
Fax Number	:	718-470-0347

Provider Business Practice Location Address
First Line	:	1752 PARK AVE STE 469
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-2811
Country	:	US
Telephone Number	:	646-686-1106
Fax Number	:

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

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	12/29/2022

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