MEDICARE: RACHANA YALAMANCHILI M.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	307878	NY

General Provider Information

NPI Number	:	1215319066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHANA YALAMANCHILI M.D.

Provider Business Mailing Address
First Line	:	10152 LEFFERTS BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11419-2006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10152 LEFFERTS BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11419-2006
Country	:	US
Telephone Number	:	718-250-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2015
Last Update Date	:	08/23/2021

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