Healthcare Provider Details

I. General information

NPI: 1609336171
Provider Name (Legal Business Name): SITARA KONERU ACHANTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVE STE 101
TOLEDO OH
43606-3819
US

IV. Provider business mailing address

2130 W CENTRAL AVE
TOLEDO OH
43606-3818
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3900
  • Fax: 419-479-6055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35.155901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: