Sanjana Reddy Mamidi, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS045038 Issued in PA

Practice address

2301 E Allegheny Ave
Philadelphia, PA 19134-4427

Phone

(215) 282-8000

NPI assigned

May 28, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1689414872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 GREYHOUND CT",
            "city": "KENDALL PARK",
            "state": "NJ",
            "postal_code": "088241492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 E ALLEGHENY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191344427",
            "telephone_number": "215-282-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Long Branch",
            "state": "NJ",
            "postal_code": "077406303",
            "country_code": "US",
            "telephone_number": "732-923-6790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAMIDI",
        "first_name": "SANJANA",
        "middle_name": "REDDY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-28",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS045038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malvern Constitution LLC
• Malvern Constitution LLC
• Priya Mamachan, DMD
• Algird R Mameniskis, M.D., F.A.C.S.
• Mamesee Home Health Care LLC
• Alicia Anne Mamienski, CRNP
• Ajit Mammen, M.B.B.S.
• Evelyn Mammen
• Mirium Mammen, DO
• Priya Elizabeth Mammen, MD

• General Practice Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.