Provider Demographics
NPI:1881939114
Name:NADUPARAMBIL, ANITHA
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:NADUPARAMBIL
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 1:1807 CAMBRIA LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5766
Mailing Address - Country:US
Mailing Address - Phone:281-494-9798
Mailing Address - Fax:
Practice Address - Street 1:2398 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1703
Practice Address - Country:US
Practice Address - Phone:516-453-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY024730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX895N17OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX760555765OtherUNITED HEALTH CARE
TX1881939114OtherTRICARE
TX760555765OtherUNITED HEALTH CARE