Provider Demographics
NPI:1992454938
Name:MELLACHERUVU, PRANAV
Entity type:Individual
Prefix:
First Name:PRANAV
Middle Name:
Last Name:MELLACHERUVU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E SPOKANE FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2131
Mailing Address - Country:US
Mailing Address - Phone:509-358-7944
Mailing Address - Fax:
Practice Address - Street 1:412 E SPOKANE FALLS BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2131
Practice Address - Country:US
Practice Address - Phone:509-358-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program