Healthcare Provider Details

I. General information

NPI: 1851329296
Provider Name (Legal Business Name): SUNITA KANTAMNENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SAINT FRANCIS DR
WATERLOO IA
50702-5644
US

IV. Provider business mailing address

2101 KIMBALL AVE LL14
WATERLOO IA
50702-5063
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8922
  • Fax: 319-272-8929
Mailing address:
  • Phone: 319-272-1590
  • Fax: 319-272-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32281
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number32281
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: