Provider Demographics
NPI:1649025909
Name:KUKKALA, SUBHA JYOTHI (NP)
Entity type:Individual
Prefix:
First Name:SUBHA
Middle Name:JYOTHI
Last Name:KUKKALA
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 1:33 E 33RD ST FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5362
Mailing Address - Country:US
Mailing Address - Phone:929-501-0535
Mailing Address - Fax:
Practice Address - Street 1:59 ONE MILE RD EXT FL 2
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2505
Practice Address - Country:US
Practice Address - Phone:844-337-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14971700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner