Provider Demographics
NPI:1124480348
Name:MANIKONDA, NEHA RAO (MD)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:RAO
Last Name:MANIKONDA
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 1:3044 OLD DENTON RD STE 138
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5099
Mailing Address - Country:US
Mailing Address - Phone:972-245-0007
Mailing Address - Fax:
Practice Address - Street 1:3044 OLD DENTON RD STE 138
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5099
Practice Address - Country:US
Practice Address - Phone:972-245-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-26
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2108208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty