Provider Demographics
NPI:1265973515
Name:MAHALI, LAKSHMI PRIYANKA
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:PRIYANKA
Last Name:MAHALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAKSHMI
Other - Middle Name:PRIYANKA
Other - Last Name:PENMETSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1152 KINGS HIGHWAY CUTOFF
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5271
Practice Address - Country:US
Practice Address - Phone:919-841-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70551207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism