Provider Demographics
NPI:1558097725
Name:MANEPALLI, VENKATA NAGA SUSHMA
Entity Type:Individual
Prefix:
First Name:VENKATA NAGA SUSHMA
Middle Name:
Last Name:MANEPALLI
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 1:902 MORTAR LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9653
Mailing Address - Country:US
Mailing Address - Phone:916-505-9169
Mailing Address - Fax:
Practice Address - Street 1:10236 GREEN LEVEL CHURCH RD STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8232
Practice Address - Country:US
Practice Address - Phone:919-297-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice