MEDICARE: SANDHYA CHILUKALA APN-C

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	363LP2300X	Primary Care Nurse Practitioner	26NJ01088100	NJ

General Provider Information

NPI Number	:	1619564705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDHYA CHILUKALA APN-C

Provider Business Mailing Address
First Line	:	199C N BEVERWYCK RD APT C9
Second Line	:
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-1423
Country	:	US
Telephone Number	:	270-992-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	199C N BEVERWYCK RD APT C9
Second Line	:
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-1423
Country	:	US
Telephone Number	:	270-992-2299
Fax Number	:

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

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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