Provider Demographics
NPI:1023538865
Name:SUKHU, AMANDA I (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:I
Last Name:SUKHU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 PUTNAM HALL BUILDING C
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8515
Mailing Address - Country:US
Mailing Address - Phone:631-632-2428
Mailing Address - Fax:814-226-3478
Practice Address - Street 1:905 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2613
Practice Address - Country:US
Practice Address - Phone:631-632-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017943207Q00000X
NY3241302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine