Provider Demographics
NPI:1750793162
Name:PRASAD, SAHODRA SR
Entity type:Individual
Prefix:
First Name:SAHODRA
Middle Name:
Last Name:PRASAD
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 EL CAMINO REAL APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3152
Mailing Address - Country:US
Mailing Address - Phone:650-271-3043
Mailing Address - Fax:
Practice Address - Street 1:824 EL CAMINO REAL APT 1
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3152
Practice Address - Country:US
Practice Address - Phone:650-271-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse