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NPI Code Detail

MEDICARE: ANIKA SUDDATH MD

MEDICARE: ANIKA SUDDATH MD
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
12084P0800XPsychiatry Physician332692-01NY

General Provider Information

NPI Number : 1790425684
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANIKA SUDDATH MD
Provider Business Mailing Address
First Line : 7559 263RD ST
Second Line :
City : GLEN OAKS
State : NY
Zip : 11004-1150
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7559 263RD ST
Second Line :
City : GLEN OAKS
State : NY
Zip : 11004-1150
Country : US
Telephone Number : 718-470-8005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2022
Last Update Date : 06/11/2026

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