Individual
AMULYA PONNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
6062 RIDGE AVE, PHILADELPHIA, PA 19128-1647
(212) 385-3700
Mailing address
6062 RIDGE AVE, PHILADELPHIA, PA 19128-1647
(610) 458-7365
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/31/2025
Last updated
01/16/2026
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