Provider Demographics
NPI:1154656445
Name:PRASAD, SUDHA MANJARI
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:MANJARI
Last Name:PRASAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4893
Mailing Address - Country:US
Mailing Address - Phone:516-742-4636
Mailing Address - Fax:516-742-4647
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-742-4636
Practice Address - Fax:516-742-4647
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics