Provider Demographics
NPI:1639476385
Name:SUKHDEO, KRYSTAL (PA)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:SUKHDEO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 5TH AVE # 748
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8703
Mailing Address - Country:US
Mailing Address - Phone:212-757-8686
Mailing Address - Fax:
Practice Address - Street 1:409 WILLIAM FLOYD PKWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3434
Practice Address - Country:US
Practice Address - Phone:212-757-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant