Provider Demographics
NPI:1407008618
Name:MUPPALANENI, SHALINI
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:MUPPALANENI
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 1:408 BLOOMING GROVE TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7841
Mailing Address - Country:US
Mailing Address - Phone:845-561-5555
Mailing Address - Fax:845-561-7571
Practice Address - Street 1:408 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7841
Practice Address - Country:US
Practice Address - Phone:845-561-5555
Practice Address - Fax:845-561-7571
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist