Provider Demographics
NPI:1518227396
Name:MEDIKAYALA, SUSHMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:
Last Name:MEDIKAYALA
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 1:4608 29TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1312
Mailing Address - Country:US
Mailing Address - Phone:914-413-1496
Mailing Address - Fax:
Practice Address - Street 1:4608 29TH ST
Practice Address - Street 2:APT 2
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1312
Practice Address - Country:US
Practice Address - Phone:914-413-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01606207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine