Provider Demographics
NPI:1922794965
Name:DALLAKOTI, SAMANATA
Entity Type:Individual
Prefix:
First Name:SAMANATA
Middle Name:
Last Name:DALLAKOTI
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 1:45 READE PLACE
Mailing Address - Street 2:4TH FLOOR, RESIDENCY SUITE
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-790-1312
Mailing Address - Fax:
Practice Address - Street 1:45 READE PLACE
Practice Address - Street 2:4TH FLOOR, RESIDENCY SUITE
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-790-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program