Healthcare Provider Details

I. General information

NPI: 1689592859
Provider Name (Legal Business Name): MANASA MAYUKHA HANUMANTHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BROOKLINE AVENUE BETH ISRAEL DEACONESS MEDICAL
BOSTON MA
02215
US

IV. Provider business mailing address

PLOT-34 8-228/A BHASKAR NAGER COLONY CHINNABONDILI PURA
SRIKAKULAM ANDHRA PREDESH
532001
IN

V. Phone/Fax

Practice location:
  • Phone: 617-667-3524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: