Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 036107630 | IL |
N | 208200000X | Surgeon | 036-107630 | IL |
N | 208600000X | Surgeon | 036-107630 | IL |
Y | 208200000X | Surgeon | MD17356 | RI |
Y | 208600000X | Surgeon | MD17356 | RI |
NPI | 1437161874 |
---|---|
Provider Name | Subhashini Manjula Ayloo |
First Address | Rumford, RI 02916-0697 |
Second Address | Providence, RI 02905-3248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 22/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I45422 | (02) | IL |