Healthcare Provider Details

I. General information

NPI: 1326987413
Provider Name (Legal Business Name): DR. SOUNDARYA CHOWDARY MANDAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CENTRAL AVE NE
ALBUQUERQUE NM
87108-1601
US

IV. Provider business mailing address

7 HEDGE CT APT 2
BUFFALO NY
14226-3750
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-6060
  • Fax: 505-255-0925
Mailing address:
  • Phone: 346-297-7409
  • 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: