Provider Demographics
NPI:1043041635
Name:KYALIKUNDA, MARY ADELLA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ADELLA
Last Name:KYALIKUNDA
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 1:55 BROOK ST APT 14
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-7738
Mailing Address - Country:US
Mailing Address - Phone:435-213-7385
Mailing Address - Fax:
Practice Address - Street 1:928 PARKER STREET
Practice Address - Street 2:494
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:435-213-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2319037163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health