Provider Demographics
NPI:1386100055
Name:MOONDRA, NEELUM
Entity type:Individual
Prefix:
First Name:NEELUM
Middle Name:
Last Name:MOONDRA
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 1:1400 BELL ISLAND TRL
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7463
Mailing Address - Country:US
Mailing Address - Phone:410-251-6773
Mailing Address - Fax:
Practice Address - Street 1:1400 BELL ISLAND TRL
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7463
Practice Address - Country:US
Practice Address - Phone:410-251-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker