Provider Demographics
NPI:1326198599
Name:VEERAMACHANENI, SAIMAMBA (MD,FACC)
Entity Type:Individual
Prefix:MRS
First Name:SAIMAMBA
Middle Name:
Last Name:VEERAMACHANENI
Suffix:
Gender:F
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5425
Mailing Address - Country:US
Mailing Address - Phone:718-802-1565
Mailing Address - Fax:718-624-7837
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:SUITE 11B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4747
Practice Address - Country:US
Practice Address - Phone:718-802-1565
Practice Address - Fax:718-624-7837
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140871207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00717313Medicaid
NY74A612Medicare ID - Type Unspecified
NYD95442Medicare UPIN