Healthcare Provider Details

I. General information

NPI: 1336061001
Provider Name (Legal Business Name): SRAVYA GUMMALURI BA, MA, LAC(NJ),NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PROVIDENCE DR
FLEMINGTON NJ
08822-3447
US

IV. Provider business mailing address

4 PROVIDENCE DR
FLEMINGTON NJ
08822-3447
US

V. Phone/Fax

Practice location:
  • Phone: 908-512-7100
  • Fax:
Mailing address:
  • Phone: 908-512-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00543800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: