Provider Demographics
NPI:1851741086
Name:THEODORE, SATHYA (MD)
Entity type:Individual
Prefix:DR
First Name:SATHYA
Middle Name:
Last Name:THEODORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SATHYA
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:358 5TH AVE RM 1003
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2209
Mailing Address - Country:US
Mailing Address - Phone:212-725-0192
Mailing Address - Fax:
Practice Address - Street 1:358 5TH AVE RM 1003
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2209
Practice Address - Country:US
Practice Address - Phone:212-725-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299559-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty