Provider Demographics
NPI:1245564079
Name:TATAPUDI, VASISHTA SURYA (MD)
Entity Type:Individual
Prefix:DR
First Name:VASISHTA
Middle Name:SURYA
Last Name:TATAPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 GRAND CONCOURSE
Mailing Address - Street 2:APARTMENT 4E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5524
Mailing Address - Country:US
Mailing Address - Phone:347-404-2555
Mailing Address - Fax:
Practice Address - Street 1:545 1ST AVE
Practice Address - Street 2:SC1-081
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6401
Practice Address - Country:US
Practice Address - Phone:347-404-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279068207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology