Provider Demographics
NPI:1730443870
Name:GUNTURU, SASIDHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SASIDHAR
Middle Name:
Last Name:GUNTURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4015
Mailing Address - Country:US
Mailing Address - Phone:718-483-1270
Mailing Address - Fax:718-299-4030
Practice Address - Street 1:57-69 WEST BURNSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4038
Practice Address - Country:US
Practice Address - Phone:718-839-8900
Practice Address - Fax:718-299-4030
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2878382084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty