Individual provider Active NPI

Kavitha Dheenadayalu, MD

  • Internal Medicine Physician
  • Little Valley, NY
National Provider Identifier
1710966742
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
002148 Issued in NY
Practice address
211 Erie St
Little Valley, NY 14755-1011
Phone
(716) 938-9666
Fax
(716) 938-9668
NPI assigned
Jan 10, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 002148 NY Primary

Addresses

Primary practice location

211 Erie St
Little Valley, NY 14755-1011

Mailing address

610 Wayne St
Olean, NY 14760-2355
Phone (716) 372-1570

Other identifiers 1

IdentifierTypeStateIssuer
02569464MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190426002042 NY Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 0648242396

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
002148NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care of Western New York, Inc. Past Accepting new patients
Exigence Hospitalist Medical Services of Olean, PLLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1710966742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 WAYNE ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147602355",
            "telephone_number": "716-372-1570",
            "fax_number": "716-373-2096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 ERIE ST",
            "city": "LITTLE VALLEY",
            "state": "NY",
            "postal_code": "147551011",
            "telephone_number": "716-938-9666",
            "fax_number": "716-938-9668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DHEENADAYALU",
        "first_name": "KAVITHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "002148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02569464",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Valley, NY

Sources for this page

Verify at the official NPI Registry.