Provider Demographics
NPI:1558615617
Name:YENNAMANDRA, ANUPAMA (OD)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:YENNAMANDRA
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 1:1430 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1904
Mailing Address - Country:US
Mailing Address - Phone:917-432-5403
Mailing Address - Fax:
Practice Address - Street 1:1430 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1904
Practice Address - Country:US
Practice Address - Phone:917-432-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-007940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist