Basic Information
| Provider Information | |||||||||
| NPI: | 1396249116 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AKELLA | ||||||||
| FirstName: | SUDHEER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1434 WILLIAMSBRIDGE RD FL 2 | ||||||||
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| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186180401 | ||||||||
| FaxNumber: | 3474791303 | ||||||||
| Practice Location | |||||||||
| Address1: | 10201 66TH RD | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113752029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188304352 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2018 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | P107523 | NY | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.