Provider Demographics
NPI:1689765190
Name:KAVURU, SUDHA (MD)
Entity Type:Individual
Prefix:
First Name:SUDHA
Middle Name:
Last Name:KAVURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUDHA
Other - Middle Name:
Other - Last Name:KAVURU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:40 BEY LEA RD
Mailing Address - Street 2:BUILDING C SUITE 202
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2900
Mailing Address - Country:US
Mailing Address - Phone:732-240-0068
Mailing Address - Fax:732-240-1574
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:BUILDING C SUITE 202
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2900
Practice Address - Country:US
Practice Address - Phone:732-240-0068
Practice Address - Fax:732-240-1574
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO7397100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist