Provider Demographics
NPI:1982032843
Name:PARVATHANENI, SUMA
Entity Type:Individual
Prefix:
First Name:SUMA
Middle Name:
Last Name:PARVATHANENI
Suffix:
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 1:1 RIVER PL
Mailing Address - Street 2:APT 1216
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4343
Mailing Address - Country:US
Mailing Address - Phone:630-835-9655
Mailing Address - Fax:
Practice Address - Street 1:1414 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3129
Practice Address - Country:US
Practice Address - Phone:212-746-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY642828-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse