Provider Demographics
NPI:1023188539
Name:MUKHI, SUDHA V (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:V
Last Name:MUKHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:435 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4413
Mailing Address - Country:US
Mailing Address - Phone:631-422-4545
Mailing Address - Fax:631-422-0530
Practice Address - Street 1:435 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4413
Practice Address - Country:US
Practice Address - Phone:631-422-4545
Practice Address - Fax:631-422-0530
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137606207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00818575Medicaid
NY13D71100Medicare UPIN