Provider Demographics
NPI:1396783999
Name:SRIVASTAVA, SUDHESH (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHESH
Middle Name:
Last Name:SRIVASTAVA
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 1:833 57TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3617
Mailing Address - Country:US
Mailing Address - Phone:718-686-7300
Mailing Address - Fax:718-633-2230
Practice Address - Street 1:833 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3617
Practice Address - Country:US
Practice Address - Phone:718-686-7300
Practice Address - Fax:718-633-2230
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220768174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02559662Medicaid
NYI05424Medicare UPIN