Provider Demographics
NPI:1194822437
Name:MYNENI, SUMANA (MD)
Entity Type:Individual
Prefix:
First Name:SUMANA
Middle Name:
Last Name:MYNENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PROSPECT STREET
Mailing Address - Street 2:NEONATOLOGY, NICU
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-577-2617
Mailing Address - Fax:603-577-5683
Practice Address - Street 1:NEONATOLOGY- PEDIATRIC HOSPITALIST
Practice Address - Street 2:8 PROSPECT STREET, NICU
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-577-2565
Practice Address - Fax:603-577-2084
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11819208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203383Medicaid
H76312Medicare UPIN
NHRE7030Medicare ID - Type Unspecified