Healthcare Provider Details

I. General information

NPI: 1306511977
Provider Name (Legal Business Name): KAVYA NALLURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

V. Phone/Fax

Practice location:
  • Phone: 857-540-8990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE20542
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: