Healthcare Provider Details

I. General information

NPI: 1134054463
Provider Name (Legal Business Name): ADITYA NELLURI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E, LOHMAN AVE, BUILDING 3, STE 300 MOUNTAINVIEW REGIONAL MEDICAL CENTER
LAS CRUCES NM
88011
US

IV. Provider business mailing address

4351 E, LOHMAN AVE, BUILDING 3, STE 300 MOUNTAINVIEW REGIONAL MEDICAL CENTER
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-7767
  • Fax:
Mailing address:
  • Phone: 575-556-7767
  • 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 StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: