Provider Demographics
NPI:1184240178
Name:SRIVATS, SUDARSHAN SRIKANTH (MD)
Entity type:Individual
Prefix:MR
First Name:SUDARSHAN
Middle Name:SRIKANTH
Last Name:SRIVATS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEW YORK PRESBYTERIAN BROOKLYN METHODIST HOSPITAL
Mailing Address - Street 2:506 6TH STREET
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:718-780-3000
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK PRESBYTERIAN BROOKLYN METHODIST HOSPITAL
Practice Address - Street 2:506 6TH STREET
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2023-04-26
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-09-27
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH23542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program