Basic Information
| Provider Information | |||||||||
| NPI: | 1710340518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLLI | ||||||||
| FirstName: | SREE | ||||||||
| MiddleName: | SINDHURA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 DEKALB AVE | ||||||||
| Address2: | HOUSE STAFF ADMINISTRATION | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015425 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859225067 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 64118 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 299849 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 64118 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 299849 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.