Healthcare Provider Details

I. General information

NPI: 1265710586
Provider Name (Legal Business Name): KISHAN NALLAPULA MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 TECH CITY CIR STE 320
ALACHUA FL
32615-7254
US

IV. Provider business mailing address

15113 NW 149TH RD
ALACHUA FL
32615-0253
US

V. Phone/Fax

Practice location:
  • Phone: 386-853-4835
  • Fax: 727-866-4393
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME125648
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number82612
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: