Provider Demographics
NPI:1396993598
Name:ANANTHA SATHYANARAYANA, SANDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:ANANTHA SATHYANARAYANA
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 1:2200 NORTHERN BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1221
Mailing Address - Country:US
Mailing Address - Phone:516-627-5262
Mailing Address - Fax:516-627-6401
Practice Address - Street 1:2200 NORTHERN BLVD STE 125
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1221
Practice Address - Country:US
Practice Address - Phone:516-627-5262
Practice Address - Fax:516-627-6401
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271777208600000X
TN52990208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery