MEDICARE: TEJASHWI PARUCHURI M.B.B.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1184556169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEJASHWI PARUCHURI M.B.B.S

Provider Business Mailing Address
First Line	:	2021 PROFESSIONAL CENTER DR.
Second Line	:	#100
City	:	ORANGE PARK
State	:	FL
Zip	:	32073
Country	:	US
Telephone Number	:	904-622-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 PROFESSIONAL CENTER DR.
Second Line	:	#100
City	:	ORANGE PARK
State	:	FL
Zip	:	32073
Country	:	US
Telephone Number	:	904-622-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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