Provider Demographics
NPI:1538137773
Name:KANCHANA, SULADA (MD)
Entity type:Individual
Prefix:DR
First Name:SULADA
Middle Name:
Last Name:KANCHANA
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 1:19 BAKER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1385
Mailing Address - Country:US
Mailing Address - Phone:845-483-5951
Mailing Address - Fax:845-483-5775
Practice Address - Street 1:19 BAKER AVE STE 301
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1385
Practice Address - Country:US
Practice Address - Phone:845-483-5951
Practice Address - Fax:845-483-5775
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2386862084N0400X
PAMD4247792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02581639Medicaid
PA1010241530001Medicaid
PA1010241530001Medicaid
I13531Medicare UPIN