Provider Demographics
NPI:1568468239
Name:WALALIYADDA, ANU (MD)
Entity Type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:WALALIYADDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CELLINI PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1666
Mailing Address - Country:US
Mailing Address - Phone:203-932-6481
Mailing Address - Fax:203-889-4953
Practice Address - Street 1:1 CELLINI PL STE 102
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1666
Practice Address - Country:US
Practice Address - Phone:203-932-6481
Practice Address - Fax:203-889-4953
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2161149OtherAETNA
CTP1943701OtherOXFORD
CT711781OtherCONNECTICARE
CT110169704OtherRAILROAD MEDICARE
CT2161149OtherAETNA
CT001370395Medicaid
CT010037039CT01OtherANTHEM BLUE SHIELD
CTG79151Medicare UPIN
CT010037039CT01OtherANTHEM BLUE SHIELD