Provider Demographics
NPI:1174210546
Name:CHAITHANYA AVANTHIKA, FNU (MD)
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:CHAITHANYA AVANTHIKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70-01 BROADWAY
Mailing Address - Street 2:ROOM A7-34 DEPARTMENT OF PEDIATRICS ELMHURST HOSPITAL C
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-334-2156
Mailing Address - Fax:718-334-2862
Practice Address - Street 1:70-01 BROADWAY
Practice Address - Street 2:ROOM A7-34 DEPARTMENT OF PEDIATRICS ELMHURST HOSPITAL C
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-334-2156
Practice Address - Fax:718-334-2862
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program