Individual
NITYANANDA RAO JAKKULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7901 BROADWAY DEPT OF, ELMHURST, NY 11373-1329
(662) 394-5006
Mailing address
1882 MCCLAIN DR, GREENVILLE, MS 38701-7623
(662) 394-5006
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
109867
NY
207XX0801X
Orthopaedic Trauma Physician
Primary
P109867
NY
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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