Individual provider Active NPI

Sudha Sreenivasan, MD

  • Psychiatry Physician
  • New Haven, CT
National Provider Identifier
1942367800
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
027592CT01 Issued in CT
Practice address
34 Park St
Connecticut Mental Health Center
New Haven, CT 06519
Phone
(203) 974-7417
Fax
(203) 974-7413
NPI assigned
Jan 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 027592CT01 CT Primary

Addresses

Primary practice location

34 Park St
Connecticut Mental Health Center
New Haven, CT 06519

Mailing address

34 Park St
Office of Care Management Connecticut Mental Health Ctr
New Haven, CT 06519
Phone (203) 974-7417

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20040526001121 CT Practitioner - Psychiatry 7012998974 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
027592CT01CTMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optimus Health Care Inc CurrentSince Jan 6, 2018 Accepting new patients
Bridges Healthcare Inc. PastSince Apr 16, 1991 Accepting new patients
Child & Family Medical, PLLC Psychiatry Past Accepting new patients
Catholic Charities, Inc. - Archdiocese of Hartford PastSince Oct 1, 2015 Accepting new patients

Locations

982 E Main St
Bridgeport, CT 06608
Phone (203) 696-3260

471 Barnum Ave
Bridgeport, CT 06608
Phone (203) 333-6864

949 Bridgeport Ave
Milford, CT 06460
Phone (203) 301-2308

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/ccaoh/r4/
  • FHIR API: https://api.qualifacts.org/api/fhir/bridgesct/r4/

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942367800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 PARK ST",
            "address_2": "OFFICE OF CARE MANAGEMENT CONNECTICUT MENTAL HEALTH CTR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06519",
            "telephone_number": "203-974-7417",
            "fax_number": "203-974-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 PARK ST",
            "address_2": "CONNECTICUT MENTAL HEALTH CENTER",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06519",
            "telephone_number": "203-974-7417",
            "fax_number": "203-974-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SREENIVASAN",
        "first_name": "SUDHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "027592CT01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.