Provider Demographics
NPI:1215191580
Name:SUDNAGUNTA, SREEDHAR P (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:SREEDHAR
Middle Name:P
Last Name:SUDNAGUNTA
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:80 E JERICHO TPKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3140
Mailing Address - Country:US
Mailing Address - Phone:516-877-2626
Mailing Address - Fax:516-877-0945
Practice Address - Street 1:80 E JERICHO TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3140
Practice Address - Country:US
Practice Address - Phone:516-877-2626
Practice Address - Fax:516-877-0945
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-09-08
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Provider Licenses
StateLicense IDTaxonomies
NY006568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant