Healthcare Provider Details

I. General information

NPI: 1114507688
Provider Name (Legal Business Name): SINDHURA VALLABHANENI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 525
HARTFORD CT
06106-5525
US

IV. Provider business mailing address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4338
  • Fax:
Mailing address:
  • Phone: 216-778-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number81719
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: