=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548032733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEPSI ANAPALLI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2023
-----------------------------------------------------
Last Update Date | 10/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4071 LEE RD STE 260
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44128-2173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-727-0124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6835 CORKWOOD KNL
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45011-8580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-501-0742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | RES.004690
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------