Healthcare Provider Details

I. General information

NPI: 1366730699
Provider Name (Legal Business Name): SINDHURA MANUBOLU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE 4TH FLOOR
BRONX NY
10456-3402
US

IV. Provider business mailing address

435 E 70TH ST APT 28 A
NEW YORK NY
10021-5342
US

V. Phone/Fax

Practice location:
  • Phone: 646-866-0110
  • Fax:
Mailing address:
  • Phone: 646-866-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP1-0040878
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number276665
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: