Provider Demographics
NPI:1164473732
Name:GUDI, RAJASHREE K
Entity Type:Individual
Prefix:
First Name:RAJASHREE
Middle Name:K
Last Name:GUDI
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 1:8301 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4412
Mailing Address - Country:US
Mailing Address - Phone:718-680-7419
Mailing Address - Fax:718-680-8194
Practice Address - Street 1:8301 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4412
Practice Address - Country:US
Practice Address - Phone:718-680-7419
Practice Address - Fax:718-680-8194
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195234207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01710030Medicaid
NY01710030Medicaid
G40817Medicare UPIN