Healthcare Provider Details

I. General information

NPI: 1104746148
Provider Name (Legal Business Name): ANURADHA NAYUDU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 E 12TH ST
OAKLAND CA
94601-3463
US

IV. Provider business mailing address

5 ABBOTT WAY
PIEDMONT CA
94618-2609
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-3500
  • Fax:
Mailing address:
  • Phone: 408-479-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberNA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: