Individual
DR. BANU PRASAD MYNENI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3235 ACADEMY AVE STE 101, PORTSMOUTH, VA 23703-3200
(757) 484-7386
Mailing address
3235 ACADEMY AVE STE 101, PORTSMOUTH, VA 23703-3200
(757) 484-7386
(757) 484-1913
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102206019
VA
207Q00000X
Family Medicine Physician
036-144866
IL
Other
Enumeration date
12/09/2014
Last updated
05/14/2024
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