Provider Demographics
NPI:1669742300
Name:ULLAGADDI, MAHANANDA (PT)
Entity type:Individual
Prefix:
First Name:MAHANANDA
Middle Name:
Last Name:ULLAGADDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAHANANDA
Other - Middle Name:S
Other - Last Name:SHETTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17228 OVERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3153
Mailing Address - Country:US
Mailing Address - Phone:704-989-8028
Mailing Address - Fax:
Practice Address - Street 1:8919 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-9600
Practice Address - Country:US
Practice Address - Phone:704-556-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist