Provider Demographics
NPI:1508916255
Name:ANASUYA, SABHAPATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SABHAPATHI
Middle Name:
Last Name:ANASUYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 BRONX BOULEVARD
Mailing Address - Street 2:PEDIATRICS CLINIC, MONTEFIORE NORTH DIVISION
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1515
Mailing Address - Country:US
Mailing Address - Phone:347-341-4303
Mailing Address - Fax:
Practice Address - Street 1:4234 BRONX BLVD
Practice Address - Street 2:PEDIATRICS CLINIC, MONTEFIORE NORTH DIVISION
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1515
Practice Address - Country:US
Practice Address - Phone:347-341-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1928682080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243563Medicaid