Provider Demographics
NPI:1215734645
Name:MADHU, SANGEETHA
Entity type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:MADHU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1616
Mailing Address - Country:US
Mailing Address - Phone:516-416-1670
Mailing Address - Fax:516-416-1670
Practice Address - Street 1:33 FULTON ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1616
Practice Address - Country:US
Practice Address - Phone:516-416-1670
Practice Address - Fax:516-416-1670
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF406793363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health