Provider Demographics
NPI:1407539695
Name:MAWILMADA, SUNITHA CHITRANJALI (OD)
Entity Type:Individual
Prefix:
First Name:SUNITHA
Middle Name:CHITRANJALI
Last Name:MAWILMADA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 GRENWICH LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6723
Mailing Address - Country:US
Mailing Address - Phone:857-540-2502
Mailing Address - Fax:
Practice Address - Street 1:4001 GRENWICH LN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-6723
Practice Address - Country:US
Practice Address - Phone:857-540-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist