Provider Demographics
NPI:1699346775
Name:RAVURU, SUNAINA DEVI (PA)
Entity type:Individual
Prefix:
First Name:SUNAINA
Middle Name:DEVI
Last Name:RAVURU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1941
Mailing Address - Country:US
Mailing Address - Phone:718-641-1117
Mailing Address - Fax:
Practice Address - Street 1:11616 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1941
Practice Address - Country:US
Practice Address - Phone:718-641-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027199OtherSTATE LICENSE