Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

PRATYUSHA MUDDALOOR MD
NPI 1043903941
Student in an Organized Health Care Education/Training Program in Syracuse, NY

Q: What is Pratyusha Muddaloor's NPI number?

The NPI number for Pratyusha Muddaloor is 1043903941. It was assigned to this individual provider in the NPPES registry on May 29, 2023.

Q: What is Pratyusha Muddaloor's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Active since May 29, 2023PECOS Enrolled

750 E. ADAMS ST, SYRACUSE, NY 13210(315) 464-5774(315) 464-5378 Get Directions Write a Review

NPPES record last updated: July 29, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 29, 2026, May 29, 2023 (2 updates tracked since 2023).

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About Pratyusha Muddaloor Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRATYUSHA MUDDALOOR MD (NPI 1043903941) is an individual student in an organized health care education/training program in Syracuse, New York, licensed in Pennsylvania (MT228586) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1043903941

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NamePRATYUSHA MUDDALOORCredential: MD

Location Address750 E. ADAMS STSyracuse, NY 13210

Mailing Address750 E. Adams St.Syracuse, NY 13210 · (315) 464-5774 · Fax (315) 464-5378

Phone(315) 464-5774

Fax(315) 464-5378

Sole ProprietorNo

Enumeration DateMay 29, 2023

Last NPPES UpdateJuly 29, 20262 updates tracked since enumeration

NPPES CertifiedJuly 29, 2026

✔ NPI 1043903941 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in PA · MT228586

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

750 E. ADAMS ST, Syracuse, NY 13210

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pratyusha Muddaloor Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. VENKATA SATISH KUMAR SAMPATHI MBBS

Anesthesiology

750 E. ADAMS ST, UPSTATE MEDICAL UNIVERSITY
SYRACUSE, NY 13210

Onondaga County (315) 469-1130

DR. FAWAZ ARAIM MD

Surgery (Vascular Surgery)