Doctor Name: | DR. SANJANA IDDYADINESH |
NPI Number: | 1548641871 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O |
License Number: | |
Business Practice Address: | 2036 Townhall Ter Apt #3 Grand Island, NY - 140721763 |
Business Phone Number: | 8649076851 |
Business Fax Number: | |
Mailing Address: | 2036 Townhall Ter, Apt #3 GRAND ISLAND |
State: | NY |
Postal Code: | 140721763 |
Phone Number: | 8649076851 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2015 |
NPI Last Update Date: | 06/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy 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. |