MEDICARE: SHREYA KURNOOL

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		LA

General Provider Information

NPI Number	:	1770427411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHREYA KURNOOL

Provider Business Mailing Address
First Line	:	8300 CONSTANTIN BLVD
Second Line	:	2ND FLOOR ADMINISTRATION
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3489
Country	:	US
Telephone Number	:	225-374-1317
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 GOODWOOD BLVD STE 202
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7851
Country	:	US
Telephone Number	:	225-765-8013
Fax Number	:

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ SHREYA KURNOOL ” Practice Location

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