Provider Demographics
NPI:1689134835
Name:GUTTIKONDA, SAI SWAPNIKA (MD)
Entity Type:Individual
Prefix:
First Name:SAI SWAPNIKA
Middle Name:
Last Name:GUTTIKONDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAI SWAPNIKA
Other - Middle Name:
Other - Last Name:GHANTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MB;BS
Mailing Address - Street 1:464 ALLEGHENY BLVD STE 2D
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-6259
Mailing Address - Country:US
Mailing Address - Phone:814-437-6793
Mailing Address - Fax:
Practice Address - Street 1:464 ALLEGHENY BLVD STE 2D
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-6259
Practice Address - Country:US
Practice Address - Phone:814-437-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD478398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program