Provider Demographics
NPI:1861981573
Name:MYNEEDU, KANCHANA
Entity type:Individual
Prefix:
First Name:KANCHANA
Middle Name:
Last Name:MYNEEDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-255-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:604 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5663
Practice Address - Country:US
Practice Address - Phone:508-842-0057
Practice Address - Fax:508-845-6571
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA289473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine