Provider Demographics
NPI:1689364069
Name:VASIREDDY, SUJITH
Entity Type:Individual
Prefix:MR
First Name:SUJITH
Middle Name:
Last Name:VASIREDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:NEUROLOGY DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-4232
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVENUE, SUNY DOWNSTATE
Practice Address - Street 2:NEUROLOGY DEPARTMENT
Practice Address - City:BOOKLYN, NEWYORK
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2024-02-16
Deactivation Date:2023-12-18
Deactivation Code:
Reactivation Date:2024-02-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program