Individual provider Active NPI

Suneetha Jakka, R.PH.

  • Pharmacist
  • New Haven, CT
National Provider Identifier
1871920918
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
0012215 Issued in CT
Practice address
382 Grand Ave
New Haven, CT 06513-3733
Phone
(203) 777-3700
Fax
(203) 777-3701
NPI assigned
Oct 3, 2013
Last updated
Jan 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0012215 CT Primary

Addresses

Primary practice location

382 Grand Ave
New Haven, CT 06513-3733

Mailing address

72 Grand Ave
New Haven, CT 06513-3997
Phone (203) 498-3479

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
0012215CTMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
My Fair Haven Pharmacy LLC Current Accepting new patients
New Haven Pharmacy, Inc PastSince Oct 1, 2022 Accepting new patients
New Haven Pharmacy, Inc Past Accepting new patients

Locations

72 Grand Ave
New Haven, CT 06513
Phone (203) 498-3479

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1871920918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133997",
            "telephone_number": "203-498-3479",
            "fax_number": "203-498-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133733",
            "telephone_number": "203-777-3700",
            "fax_number": "203-777-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKKA",
        "first_name": "SUNEETHA",
        "name_prefix": "Mrs.",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-03",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "0012215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.