Healthcare Provider Details

I. General information

NPI: 1477583235
Provider Name (Legal Business Name): SUMALATHA MANNAVA M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 W MCDOWELL RD
PHOENIX AZ
85035-3862
US

IV. Provider business mailing address

PO BOX 746093
ATLANTA GA
30374-6093
US

V. Phone/Fax

Practice location:
  • Phone: 602-671-7068
  • Fax: 602-671-6946
Mailing address:
  • Phone: 602-671-7068
  • Fax: 602-671-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07699000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64736
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: