Healthcare Provider Details

I. General information

NPI: 1659937696
Provider Name (Legal Business Name): KUNAL MISHRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE # MC27-75
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

100 N ACADEMY AVE # MC27-75
DANVILLE PA
17822-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6423
  • Fax:
Mailing address:
  • Phone: 570-271-6423
  • 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 StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOT025456
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: