Provider Demographics
NPI:1275388225
Name:PRABHUDESAI, SAMRUDDHI UDAY (MS)
Entity type:Individual
Prefix:
First Name:SAMRUDDHI
Middle Name:UDAY
Last Name:PRABHUDESAI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6796
Mailing Address - Country:US
Mailing Address - Phone:929-306-6928
Mailing Address - Fax:929-419-9061
Practice Address - Street 1:136 MADISON AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6796
Practice Address - Country:US
Practice Address - Phone:929-306-6928
Practice Address - Fax:929-419-9061
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health