Healthcare Provider Details

I. General information

NPI: 1831959568
Provider Name (Legal Business Name): MEGHANA KUNAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

5901 W BEHREND DR APT 1138
GLENDALE AZ
85308-6968
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7249
  • Fax:
Mailing address:
  • Phone: 303-396-2502
  • 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: