Active NPI
Sridhar B Kadiyala, MBBS., PH.D.
- Psychiatry Physician
- Northport, NY
National Provider Identifier
1619396793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 292923
- Practice address
- 79 Middleville Rd
Northport, NY 11768 - Phone
- (631) 261-4400
- NPI assigned
- Apr 16, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 292923 | NY | Primary |
Addresses
Primary practice location
79 Middleville Rd
Northport, NY 11768
Mailing address
662 Veterans Hwy Apt 2F
Hauppauge, NY 11788-1224
Phone (518) 763-7843
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 292923 | NY | MD | Psychiatry Physician |
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535500800000",
"number": "1619396793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "662 VETERANS HWY APT 2F",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117881224",
"telephone_number": "518-763-7843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 MIDDLEVILLE RD",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "11768",
"telephone_number": "631-261-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KADIYALA",
"first_name": "SRIDHAR",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "MBBS., PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-16",
"last_updated": "2018-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "292923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.