Provider Demographics
NPI:1295910321
Name:CHELLIAH, KANAKA LAKSHMY (MD)
Entity type:Individual
Prefix:DR
First Name:KANAKA LAKSHMY
Middle Name:
Last Name:CHELLIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANAKA
Other - Middle Name:L
Other - Last Name:CHELLIAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4500 N SONOMA RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7334
Mailing Address - Country:US
Mailing Address - Phone:575-652-4048
Mailing Address - Fax:575-556-9766
Practice Address - Street 1:4500 N SONOMA RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7334
Practice Address - Country:US
Practice Address - Phone:575-652-4048
Practice Address - Fax:575-556-9766
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01422081Medicaid
NM01422081Medicaid