Provider Demographics
NPI:1295749505
Name:BELLUMKONDA, LAVANYA (MBBS)
Entity type:Individual
Prefix:DR
First Name:LAVANYA
Middle Name:
Last Name:BELLUMKONDA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CORPORATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6266
Mailing Address - Country:US
Mailing Address - Phone:203-929-9799
Mailing Address - Fax:
Practice Address - Street 1:4 CORPORATE DR STE 100
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6266
Practice Address - Country:US
Practice Address - Phone:203-929-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46542207RC0000X
CT5969207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology