BANU PRASAD MYNENI DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036144866

License Status

NOT RENEWED

Business

Title

First Name

BANU

Middle

PRASAD

Last Name

MYNENI

Business Name

BANU PRASAD MYNENI DO

Original Issue Date

12/29/2017

Effective Date

12/29/2017

Expiration Date

09/30/2020

City

IMPERIAL

State

Zip

15126

County

PENNSYLVANIA

Ever Disciplined

LastModifiedDate

01/14/2021