Provider Demographics
NPI:1467780882
Name:MADHO, SEWPERSAUD R (CP,)
Entity Type:Individual
Prefix:
First Name:SEWPERSAUD
Middle Name:R
Last Name:MADHO
Suffix:
Gender:M
Credentials:CP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 PARKWOOD BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2525
Mailing Address - Country:US
Mailing Address - Phone:518-370-3005
Mailing Address - Fax:518-370-3005
Practice Address - Street 1:1479 PARKWOOD BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2525
Practice Address - Country:US
Practice Address - Phone:518-370-3005
Practice Address - Fax:518-370-3005
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP003663224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY400202272001OtherCDPHP
NY400202272001OtherCDPHP