Provider Demographics
NPI:1891136875
Name:VENKATARAMAN, SATHYANARAYANAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:SATHYANARAYANAN
Middle Name:
Last Name:VENKATARAMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 GRACE CT
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2913
Mailing Address - Country:US
Mailing Address - Phone:631-278-1960
Mailing Address - Fax:
Practice Address - Street 1:423 GRACE CT
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2913
Practice Address - Country:US
Practice Address - Phone:631-278-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004990171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist