Healthcare Provider Details

I. General information

NPI: 1952155657
Provider Name (Legal Business Name): SRAVYA SRI KUCHIPUDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 12/24/2024
Certification Date:
Deactivation Date: 12/12/2024
Reactivation Date: 12/24/2024

III. Provider practice location address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

IV. Provider business mailing address

1100 ROBLEY DRIVE APT 4202
LAFAYETTE LA
70503
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-6166
  • Fax: 337-261-6129
Mailing address:
  • Phone: 337-261-6166
  • Fax: 337-261-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number342523
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: