Healthcare Provider Details

I. General information

NPI: 1962843730
Provider Name (Legal Business Name): ANU MALLAPATY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

40 SUNSHINE COTTAGE RD
VALHALLA NY
10595-1524
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7585
  • Fax:
Mailing address:
  • Phone: 914-493-7585
  • Fax: 914-449-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberX
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number288186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: