Provider Demographics
NPI:1124265749
Name:PANDEY, SUSHMA SAPKOTA (MD)
Entity type:Individual
Prefix:
First Name:SUSHMA SAPKOTA
Middle Name:
Last Name:PANDEY
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 1:1500 NORTH JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-338-7000
Mailing Address - Fax:315-338-7629
Practice Address - Street 1:13407 STATE ROUTE 12
Practice Address - Street 2:BOONVILLE FAMILY CARE
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309
Practice Address - Country:US
Practice Address - Phone:315-942-3500
Practice Address - Fax:315-942-3618
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03161786Medicaid
NYJ400049087Medicare PIN
NY03161786Medicaid
J400008674Medicare PIN