MEDICARE: BHAVANA KANCHERLA M.A., CCC/A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	01033	MD
2	237600000X	Audiologist-Hearing Aid Fitter	80232	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023016862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHAVANA KANCHERLA M.A., CCC/A

Provider Business Mailing Address
First Line	:	1208 TAMRANAE CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-6860
Country	:	US
Telephone Number	:	412-855-9296
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 TAMRANAE CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-6860
Country	:	US
Telephone Number	:	412-855-9296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	05/20/2019

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