Provider Demographics
NPI:1912484056
Name:SUDHA, SARI (RN)
Entity Type:Individual
Prefix:MS
First Name:SARI
Middle Name:
Last Name:SUDHA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MURRAY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3139
Mailing Address - Country:US
Mailing Address - Phone:718-813-8452
Mailing Address - Fax:
Practice Address - Street 1:1714 MURRAY ST FL 1
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3139
Practice Address - Country:US
Practice Address - Phone:718-813-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639211163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse