Individual ProviderSuparna Dandamudi PatchaPediatricsAllopathic & Osteopathic PhysiciansPractice Address315 W 57th St Ste 404, New York, NY 10019-3147(888) 603-0993(888) 603-9338PECOS EnrollmentBased on the most recent information from CMS, provider Suparna Dandamudi Patcha does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1689724643Provider TypeIndividualFull NameDandamudi Patcha, SuparnaCredentialM.B.B.SGenderFemaleSole ProprietorNoEnumeration Date1/11/2007Last Updated10/28/2019Contact InformationPractice LocationPractice Address315 W 57th St Ste 404, New York, NY 10019-3147Phone(888) 603-0993FaxUnlisted FaxMailing LocationMailing Address330 W 58th St Ste 414, New York, NY 10019-1819Phone(888) 603-9338Fax(212) 624-0213Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicense298886-1New YorkCode208000000XDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseMA066981New Jersey