Provider Demographics
NPI:1023016862
Name:KANCHERLA, BHAVANA (MA, CCC/A)
Entity Type:Individual
Prefix:
First Name:BHAVANA
Middle Name:
Last Name:KANCHERLA
Suffix:
Gender:F
Credentials:MA, CCC/A
Other - Prefix:
Other - First Name:BHAVANA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/A
Mailing Address - Street 1:1208 TAMRANAE CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6860
Mailing Address - Country:US
Mailing Address - Phone:412-855-9296
Mailing Address - Fax:
Practice Address - Street 1:1208 TAMRANAE CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6860
Practice Address - Country:US
Practice Address - Phone:412-855-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01033231H00000X
TX80232237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1023016862Medicaid
MDQ02501Medicare UPIN