Provider Demographics
NPI:1659810141
Name:KHADILKAR, SUMEDHA M
Entity Type:Individual
Prefix:MRS
First Name:SUMEDHA
Middle Name:M
Last Name:KHADILKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 JOHN MUIR DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1144
Mailing Address - Country:US
Mailing Address - Phone:716-250-4137
Mailing Address - Fax:
Practice Address - Street 1:95 JOHN MUIR DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-1144
Practice Address - Country:US
Practice Address - Phone:716-250-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010860225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant