Provider Demographics
NPI:1285609024
Name:AVULA, SATYANARAYAN (MD)
Entity type:Individual
Prefix:DR
First Name:SATYANARAYAN
Middle Name:
Last Name:AVULA
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 1:1285 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1562
Mailing Address - Country:US
Mailing Address - Phone:718-370-3020
Mailing Address - Fax:718-494-3566
Practice Address - Street 1:1285 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1562
Practice Address - Country:US
Practice Address - Phone:718-370-3020
Practice Address - Fax:718-494-3566
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131633173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50A221Medicare PIN