Provider Demographics
NPI:1841723699
Name:KONADA, SOUJANIYA (PT)
Entity type:Individual
Prefix:MRS
First Name:SOUJANIYA
Middle Name:
Last Name:KONADA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PALISADE AVE
Mailing Address - Street 2:APT 24
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-3404
Mailing Address - Country:US
Mailing Address - Phone:318-538-8420
Mailing Address - Fax:
Practice Address - Street 1:3010 WESTCHESTER AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2535
Practice Address - Country:US
Practice Address - Phone:914-328-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041350-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist