Healthcare Provider Details

I. General information

NPI: 1831310275
Provider Name (Legal Business Name): SOUMYA LAKSHMI PANDALAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOUMYA LAKSHMI PANDALAI MD

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 E MAIN ST
WHITEHALL OH
43213-2925
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 400
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax:
Mailing address:
  • Phone: 833-510-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.120211
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35.120211
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208000000X
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: