Provider Demographics
NPI:1306893201
Name:SADANANDAN, SWAYAMPRABHA (MD)
Entity type:Individual
Prefix:
First Name:SWAYAMPRABHA
Middle Name:
Last Name:SADANANDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWAYAMPRABHA
Other - Middle Name:RAMAN
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:85 RADCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1616
Mailing Address - Country:US
Mailing Address - Phone:718-250-6074
Mailing Address - Fax:718-250-6518
Practice Address - Street 1:85 RADCLIFF AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1616
Practice Address - Country:US
Practice Address - Phone:718-250-6074
Practice Address - Fax:718-250-6518
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1373452080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00649752Medicaid