Provider Demographics
NPI:1386288249
Name:RAJYAM, SANGEETHA
Entity type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:RAJYAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1920
Mailing Address - Country:US
Mailing Address - Phone:607-220-9068
Mailing Address - Fax:
Practice Address - Street 1:149 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1920
Practice Address - Country:US
Practice Address - Phone:607-220-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist