Healthcare Provider Details

I. General information

NPI: 1467147991
Provider Name (Legal Business Name): NIKITA REDDY CHINTAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S. OHIO AVE
ATLANTIC CITY NJ
08401
US

IV. Provider business mailing address

2857 MOUNTAIN LAUREL TRL
CANTONMENT FL
32533-4771
US

V. Phone/Fax

Practice location:
  • Phone: 609-464-2564
  • Fax:
Mailing address:
  • Phone: 332-216-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53450
License Number StateAL
# 2
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: