Healthcare Provider Details

I. General information

NPI: 1639554314
Provider Name (Legal Business Name): ANUSHA BOYANPALLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S ORANGE AVE MSB-C596
NEWARK NJ
07103-2757
US

IV. Provider business mailing address

13 FRANK E RODGERS BLVD N APT # 2
HARRISON NJ
07029-1421
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-3106
  • Fax:
Mailing address:
  • Phone: 412-600-1229
  • 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: