Healthcare Provider Details

I. General information

NPI: 1447208277
Provider Name (Legal Business Name): BHAVANI MAHANKALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 SENECA AVE
RIDGEWOOD NY
11385-1340
US

IV. Provider business mailing address

385 SENECA AVE
RIDGEWOOD NY
11385-1340
US

V. Phone/Fax

Practice location:
  • Phone: 718-899-0060
  • Fax: 718-559-6758
Mailing address:
  • Phone: 718-899-0060
  • Fax: 718-559-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number224539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: