Provider Demographics
NPI:1033388715
Name:KANTAMANENI, SANDHYA RANI
Entity Type:Individual
Prefix:
First Name:SANDHYA
Middle Name:RANI
Last Name:KANTAMANENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 AVALON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7285
Mailing Address - Country:US
Mailing Address - Phone:810-240-9330
Mailing Address - Fax:
Practice Address - Street 1:429 AVALON LAKE RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7285
Practice Address - Country:US
Practice Address - Phone:810-240-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0010879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist