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General NPI Number Information
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NPI Number | 1669835013
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Entity Type | Individual
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Provider Name | SMITHA NEERUKONDA
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Gender | Female
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Dates
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Enumeration Date | 04/03/2016
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 2301 HOUSE AVE STE 301
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City | CHEYENNE
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State | WY
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Zip | 82001-3178
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Country | US
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Telephone | 307-637-1600
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Fax | 307-637-1699
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Provider Business Mailing Address
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Address Line | PO BOX 20970
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City | CHEYENNE
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State | WY
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Zip | 82003-7020
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Country | US
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Telephone | 307-634-2273
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 18294A
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License Number State | WY
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