Provider Demographics
NPI:1558705251
Name:CHALIKONDA, NITHYA
Entity type:Individual
Prefix:
First Name:NITHYA
Middle Name:
Last Name:CHALIKONDA
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 1:425 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1952
Mailing Address - Country:US
Mailing Address - Phone:267-218-5427
Mailing Address - Fax:
Practice Address - Street 1:425 WELLINGTON DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-1952
Practice Address - Country:US
Practice Address - Phone:267-218-5427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122541223X0400X
PADS0400611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics