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Individual
KALYANI SAMUDRA
Active
Individual
KALYANI SAMUDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
6079971-1205
UT
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
6079971-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60799711200001
BLUE CROSS PROVIDER #
UT
Enumeration date
03/07/2006
Last updated
11/17/2021
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