Healthcare Provider Details

I. General information

NPI: 1871239632
Provider Name (Legal Business Name): DIVYA BALA ANTHONY M SALIBINDLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date: 12/13/2022
Reactivation Date: 01/25/2023

III. Provider practice location address

3188 BELLEVUE AVENUE SUITE 110 ML:0533
CINCINNATI OH
45219
US

IV. Provider business mailing address

3336 JEFFERSON AVE APT 11
CINCINNATI OH
45220-2113
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7043
  • Fax:
Mailing address:
  • Phone: 513-764-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: