Active NPI
Srinivas Rao Myneni Venkatasatya, DDS, PHD
- Periodontics
- Stony Brook, NY
National Provider Identifier
1639524192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 000063-1
- Practice address
- 108 Rockland HL
Stony Brook, NY 11794-8703 - Phone
- (631) 632-8739
- NPI assigned
- May 3, 2016
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 000063-1 | NY | Primary |
Addresses
Primary practice location
108 Rockland HL
Stony Brook, NY 11794-8703
Mailing address
7 Presidents Dr
Apt 4B
Port Jefferson, NY 11777-2055
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000063-1 | NY | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462233600000",
"number": "1639524192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 PRESIDENTS DR",
"address_2": "APT 4B",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 ROCKLAND HL",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117948703",
"telephone_number": "631-632-8739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYNENI VENKATASATYA",
"first_name": "SRINIVAS RAO",
"credential": "DDS, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-03",
"last_updated": "2016-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "000063-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.