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General NPI Number Information
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NPI Number | 1649946823
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Entity Type | Individual
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Provider Name | RAJI ANAND MADDELA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 950 CAMPBELL AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-2770
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Country | US
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Telephone | 203-932-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 85 PERRY MERRILL DR
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City | WEST HAVEN
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State | CT
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Zip | 06516-7706
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Country | US
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Telephone | 203-809-9281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 10143
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 163942
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License Number State | CT
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