Provider Demographics
NPI:1104856160
Name:NAIDU, SACHIDANANDAN (MD)
Entity Type:Individual
Prefix:
First Name:SACHIDANANDAN
Middle Name:
Last Name:NAIDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1253
Mailing Address - Country:US
Mailing Address - Phone:405-341-7009
Mailing Address - Fax:405-330-1811
Practice Address - Street 1:1919 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-1253
Practice Address - Country:US
Practice Address - Phone:405-341-7009
Practice Address - Fax:405-330-1811
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21643174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100251100AMedicaid
OK1104856160OtherBLUE SHIELD
OK100251100AMedicaid
OKH45755Medicare UPIN