Provider Demographics
NPI:1013340926
Name:PRASAD, ANCHALA
Entity Type:Individual
Prefix:
First Name:ANCHALA
Middle Name:
Last Name:PRASAD
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 1:223 E 14TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3200
Mailing Address - Country:US
Mailing Address - Phone:402-461-4931
Mailing Address - Fax:402-461-4932
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:402-461-4931
Practice Address - Fax:402-461-4932
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECFM02737224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter