Provider Demographics
NPI:1487956140
Name:THOTTAM, SUJITHA NICHOLAS (ANP/GNP)
Entity type:Individual
Prefix:MRS
First Name:SUJITHA
Middle Name:NICHOLAS
Last Name:THOTTAM
Suffix:
Gender:F
Credentials:ANP/GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82-68 164TH STREET, QUEENS HOSPITAL CENTER
Mailing Address - Street 2:N BUILDING-733
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1121
Mailing Address - Country:US
Mailing Address - Phone:516-358-4001
Mailing Address - Fax:
Practice Address - Street 1:8268 164TH ST
Practice Address - Street 2:N BUILDING-733
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305475-1363LA2200X
NYF340781-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology