Healthcare Provider Details

I. General information

NPI: 1912814146
Provider Name (Legal Business Name): RENOVANCE HEALTH WEIGHT MANAGEMENT AND OBESITY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 N STE 117
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

66 APPLEGATE WAY
CHESTERFIELD NJ
08515-9636
US

V. Phone/Fax

Practice location:
  • Phone: 732-561-5685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VENKATA SHILPA REDDY KALLI
Title or Position: OWNER
Credential: MD
Phone: 732-561-5685