Provider Demographics
NPI:1508980566
Name:PRASAD, SUDEEPTHI HB (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDEEPTHI
Middle Name:HB
Last Name:PRASAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2299 MOWRY AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1621
Mailing Address - Country:US
Mailing Address - Phone:510-304-8990
Mailing Address - Fax:510-304-8990
Practice Address - Street 1:2299 MOWRY AVE STE 3A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1621
Practice Address - Country:US
Practice Address - Phone:510-304-8990
Practice Address - Fax:510-304-8990
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 99807OtherMEDICAL LICENSE
NVBP8573998OtherDEA CERTIFICATE