Provider Demographics
NPI:1457625022
Name:SAKUNALA, YAMINI CHANDRAKALA (NP)
Entity Type:Individual
Prefix:MRS
First Name:YAMINI
Middle Name:CHANDRAKALA
Last Name:SAKUNALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 S NEW PROSPECT RD
Mailing Address - Street 2:271
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1736
Mailing Address - Country:US
Mailing Address - Phone:732-244-4700
Mailing Address - Fax:
Practice Address - Street 1:271 S NEW PROSPECT RD
Practice Address - Street 2:271
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1736
Practice Address - Country:US
Practice Address - Phone:732-244-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00326800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily