Provider Demographics
NPI:1477346757
Name:DAMPELLA, ANAND KAMAL
Entity type:Individual
Prefix:
First Name:ANAND
Middle Name:KAMAL
Last Name:DAMPELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37644 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4038
Mailing Address - Country:US
Mailing Address - Phone:585-576-5636
Mailing Address - Fax:
Practice Address - Street 1:37644 BAYLOR DR
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4038
Practice Address - Country:US
Practice Address - Phone:585-576-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704356311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily