Provider Demographics
NPI:1861604795
Name:KANDULA, SWETHA (MD)
Entity type:Individual
Prefix:DR
First Name:SWETHA
Middle Name:
Last Name:KANDULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 HILL ROAD, SUITE 2B
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-658-7546
Mailing Address - Fax:973-425-5683
Practice Address - Street 1:3695 HILL ROAD, SUITE 2B
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-658-7546
Practice Address - Fax:973-425-5683
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09358000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093554AMedicaid
MA002797501Medicare PIN