Provider Demographics
NPI:1871239632
Name:SALIBINDLA, DIVYA BALA ANTHONY M
Entity Type:Individual
Prefix:
First Name:DIVYA BALA ANTHONY M
Middle Name:
Last Name:SALIBINDLA
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 1:3336 JEFFERSON AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2113
Mailing Address - Country:US
Mailing Address - Phone:513-764-8731
Mailing Address - Fax:
Practice Address - Street 1:3188 BELLEVUE AVENUE
Practice Address - Street 2:SUITE 110 ML:0533
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-558-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2023-02-08
Deactivation Date:2022-12-13
Deactivation Code:
Reactivation Date:2023-01-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program