Provider Demographics
NPI:1619142387
Name:ADURY, KAMALA SUNDARI (MD)
Entity type:Individual
Prefix:DR
First Name:KAMALA
Middle Name:SUNDARI
Last Name:ADURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3364 PRAIRIE VISTA CT
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9079
Mailing Address - Country:US
Mailing Address - Phone:234-564-6646
Mailing Address - Fax:234-517-6646
Practice Address - Street 1:805 E WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3331
Practice Address - Country:US
Practice Address - Phone:234-564-6646
Practice Address - Fax:234-517-6646
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0924152084S0012X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3083005Medicaid
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #