Healthcare Provider Details

I. General information

NPI: 1053872523
Provider Name (Legal Business Name): MALLIKA MANYAPU MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 08/31/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY RD
PARKER AZ
85344-7718
US

IV. Provider business mailing address

1425 P ST NW APT 503
WASHINGTON DC
20005-1962
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-2137
  • Fax:
Mailing address:
  • Phone: 678-640-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD210011428
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number327798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: