Provider Demographics
NPI:1952114431
Name:NDAMA, MIATTA
Entity type:Individual
Prefix:
First Name:MIATTA
Middle Name:
Last Name:NDAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4927
Mailing Address - Country:US
Mailing Address - Phone:317-397-3678
Mailing Address - Fax:
Practice Address - Street 1:1006 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4927
Practice Address - Country:US
Practice Address - Phone:317-397-3678
Practice Address - Fax:317-397-3678
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program