Provider Demographics
NPI:1548757131
Name:DADEBOYINA, CHANDRAKALA
Entity Type:Individual
Prefix:
First Name:CHANDRAKALA
Middle Name:
Last Name:DADEBOYINA
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:GUTHRIE/ROBERTPACKER HOSPITAL
Mailing Address - Street 2:INTERNAL MEDICINE RESIDENCY,1 GUTHRIE SQUARE
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840
Mailing Address - Country:US
Mailing Address - Phone:570-887-4559
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-887-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program