Healthcare Provider Details

I. General information

NPI: 1801579685
Provider Name (Legal Business Name): SHRUTHI PULIMAMIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTH GLOSTER STREET
TUPELO MS
38801
US

IV. Provider business mailing address

3400 MCCULLOUGH BLVD APT 314
BELDEN MS
38826-9462
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-3000
  • Fax:
Mailing address:
  • Phone: 425-633-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: