Provider Demographics
NPI:1235107160
Name:PATTISAPU, SUNEETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNEETHA
Middle Name:
Last Name:PATTISAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 DAYTON LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2859
Mailing Address - Country:US
Mailing Address - Phone:914-739-0087
Mailing Address - Fax:914-737-1714
Practice Address - Street 1:1980 CROMPOND ROAD
Practice Address - Street 2:
Practice Address - City:CORTLAND MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-734-3324
Practice Address - Fax:914-737-6304
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2174581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH30129Medicare UPIN