Healthcare Provider Details

I. General information

NPI: 1457625022
Provider Name (Legal Business Name): YAMINI CHANDRAKALA SAKUNALA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 S NEW PROSPECT RD 271
JACKSON NJ
08527-1736
US

IV. Provider business mailing address

271 S NEW PROSPECT RD 271
JACKSON NJ
08527-1736
US

V. Phone/Fax

Practice location:
  • Phone: 732-244-4700
  • Fax:
Mailing address:
  • Phone: 732-244-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00326800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: