Provider Demographics
NPI:1548897002
Name:SAKHAMURI, PAVANA LALITHYA
Entity type:Individual
Prefix:
First Name:PAVANA LALITHYA
Middle Name:
Last Name:SAKHAMURI
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 1:5248 FIELDCREST AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2400
Mailing Address - Country:US
Mailing Address - Phone:469-264-9468
Mailing Address - Fax:
Practice Address - Street 1:5248 FIELDCREST AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2400
Practice Address - Country:US
Practice Address - Phone:469-264-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program