Healthcare Provider Details

I. General information

NPI: 1508451303
Provider Name (Legal Business Name): SINDHU KANIKICHARLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S CLINTON AVE STE 125
ROCHESTER NY
14618-2668
US

IV. Provider business mailing address

625 ELMWOOD AVE OFC 410
ROCHESTER NY
14620-2913
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-2312
  • Fax:
Mailing address:
  • Phone: 623-223-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberLL879
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number000149-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: