Provider Demographics
NPI:1982380358
Name:ISUKAPALLI, SRIVALLI (PA-C)
Entity Type:Individual
Prefix:
First Name:SRIVALLI
Middle Name:
Last Name:ISUKAPALLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HIGHWAY
Mailing Address - Street 2:HHC-CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1177 SUMMER ST FL 5
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5522
Practice Address - Country:US
Practice Address - Phone:203-353-1133
Practice Address - Fax:203-653-3398
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-09-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant