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NPI Code Detail

MEDICARE: MANVI PUNUKOLLU

MEDICARE: MANVI PUNUKOLLU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1043153042
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANVI PUNUKOLLU
Provider Business Mailing Address
First Line : 4723 VILLAGE DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-5721
Country : US
Telephone Number : 703-223-2449
Fax Number :
Provider Business Practice Location Address
First Line : 1801 ROZZELLES FERRY RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-4228
Country : US
Telephone Number : 704-446-9987
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ MANVI PUNUKOLLU ” Practice Location

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