Provider Demographics
NPI:1932628500
Name:YADAVA, SANJAY KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:KUMAR
Last Name:YADAVA
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 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-7287
Mailing Address - Fax:
Practice Address - Street 1:725 IRVING AVE STE 311
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1685
Practice Address - Country:US
Practice Address - Phone:315-464-5815
Practice Address - Fax:315-464-9150
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine