Provider Demographics
NPI:1013093707
Name:KANKANALA, SNEHALATHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SNEHALATHA
Middle Name:
Last Name:KANKANALA
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 1:5419 N LOVINGTON HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240
Mailing Address - Country:US
Mailing Address - Phone:505-392-7537
Mailing Address - Fax:505-392-2874
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:505-392-7537
Practice Address - Fax:505-392-2874
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8361208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00020412Medicaid
C97877Medicare UPIN
NM00020412Medicaid