Provider Demographics
NPI:1861700221
Name:POTLURI, SUNEETHA (RPA-C)
Entity type:Individual
Prefix:
First Name:SUNEETHA
Middle Name:
Last Name:POTLURI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 PELHAM PKWY S
Mailing Address - Street 2:APT # 1L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1112
Mailing Address - Country:US
Mailing Address - Phone:347-657-0653
Mailing Address - Fax:
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-430-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014095-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant