Healthcare Provider Details

I. General information

NPI: 1639800170
Provider Name (Legal Business Name): MRUNALINI DANDAMUDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2594
US

IV. Provider business mailing address

4422 3RD AVE UNIT 6H
BRONX NY
10457-2594
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6202
  • Fax:
Mailing address:
  • Phone: 718-960-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36641
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: