Provider Demographics
NPI:1619564705
Name:CHILUKALA, SANDHYA (APN-C)
Entity Type:Individual
Prefix:
First Name:SANDHYA
Middle Name:
Last Name:CHILUKALA
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199C N BEVERWYCK RD APT C9
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-1423
Mailing Address - Country:US
Mailing Address - Phone:270-992-2299
Mailing Address - Fax:
Practice Address - Street 1:199C N BEVERWYCK RD APT C9
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-1423
Practice Address - Country:US
Practice Address - Phone:270-992-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01088100363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty