Provider Demographics
NPI: | 1134137292 |
---|---|
Name: | RAYUDU, SUNITA (MD) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | SUNITA |
Middle Name: | |
Last Name: | RAYUDU |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | SUNITA |
Other - Middle Name: | S |
Other - Last Name: | PENUMALLA |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | PO BOX 14890 |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBANY |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12212-4890 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-525-5634 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1270 BELMONT AVE |
Practice Address - Street 2: | |
Practice Address - City: | SCHENECTADY |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12308-2104 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-496-0730 |
Practice Address - Fax: | 518-389-1788 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-04 |
Last Update Date: | 2021-06-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 226233 | 207R00000X, 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 0023884 | Medicaid | |
NJ | 0023884 | Medicaid | |
NY | 02523637 | Medicaid | |
NY | 0023884 | Medicaid | |
NJ | 0023884 | Medicaid | |
NJ | I00932 | Medicare UPIN | |
NJ | 078458 | Medicare ID - Type Unspecified |