Provider Demographics
NPI:1942324116
Name:MENON, ANANADAVALLI (MD)
Entity Type:Individual
Prefix:
First Name:ANANADAVALLI
Middle Name:
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 GENESEE ST.
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3804
Mailing Address - Country:US
Mailing Address - Phone:315-272-2600
Mailing Address - Fax:315-733-8167
Practice Address - Street 1:195-199 W. DOMINICK ST.
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5855
Practice Address - Country:US
Practice Address - Phone:315-272-2730
Practice Address - Fax:315-337-0675
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112914-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry