Provider Demographics
NPI:1073535043
Name:NARENDRA, SUDHANSHU (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHANSHU
Middle Name:
Last Name:NARENDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2012
Mailing Address - Country:US
Mailing Address - Phone:718-843-2244
Mailing Address - Fax:
Practice Address - Street 1:10314 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11419-2012
Practice Address - Country:US
Practice Address - Phone:718-843-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00899376Medicaid
NY0092519Medicare ID - Type Unspecified
NY00899376Medicaid