Healthcare Provider Details

I. General information

NPI: 1518199561
Provider Name (Legal Business Name): NEHA DHURI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 W 71ST ST STE 102
INDIANAPOLIS IN
46278-1785
US

IV. Provider business mailing address

5980 W 71ST ST STE 102
INDIANAPOLIS IN
46278-1785
US

V. Phone/Fax

Practice location:
  • Phone: 317-388-0800
  • Fax: 317-388-0805
Mailing address:
  • Phone: 317-388-0800
  • Fax: 317-388-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number031045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: