Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | BP1-0040878 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 276665 | NY |
NPI | 1366730699 |
---|---|
Provider Name | Dr. Sindhura Manubolu |
First Address | New York, NY 10021-5342 |
Second Address | Bronx, NY 10456-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 12/11/2015 |