Provider Demographics
NPI:1942938790
Name:CHINTAMADAKA, GAYATHRI
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:
Last Name:CHINTAMADAKA
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 1:2301 N 174TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2743
Mailing Address - Country:US
Mailing Address - Phone:848-247-9445
Mailing Address - Fax:
Practice Address - Street 1:2301 N 174TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2743
Practice Address - Country:US
Practice Address - Phone:848-247-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant