Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 207R00000X | AZ |
N | 111NI0900X | Internist | 207R00000X | AZ |
N | 207RA0401X | Internist - Addiction Medicine | 35.120211 | OH |
Y | 207RA0401X | Internist - Addiction Medicine | 35120211 | OH |
N | 208000000X | Pediatrician | 208000000X | AZ |
NPI | 1831310275 |
---|---|
Provider Name | Dr. Soumya Lakshmi Pandalai |
First Address | Blue Ash, OH 45241-3158 |
Second Address | Phoenix, AZ 85006-2850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 25/10/2019 |