Healthcare Provider Details

I. General information

NPI: 1417324583
Provider Name (Legal Business Name): SANKALPA BANDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST
APPLETON WI
54911-3454
US

IV. Provider business mailing address

1818 N MEADE ST
APPLETON WI
54911-3454
US

V. Phone/Fax

Practice location:
  • Phone: 920-735-7645
  • Fax: 920-735-7618
Mailing address:
  • Phone: 920-735-7645
  • Fax: 920-735-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68511-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number68511
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: