Provider Demographics
NPI:1982881900
Name:VATTI, ROJASUDHA (MD)
Entity Type:Individual
Prefix:
First Name:ROJASUDHA
Middle Name:
Last Name:VATTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 QUEENS BLVD
Mailing Address - Street 2:APT # 12 G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7301
Mailing Address - Country:US
Mailing Address - Phone:347-233-4517
Mailing Address - Fax:
Practice Address - Street 1:10460 QUEENS BLVD
Practice Address - Street 2:APT # 12 G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7301
Practice Address - Country:US
Practice Address - Phone:347-233-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine