Healthcare Provider Details

I. General information

NPI: 1811301419
Provider Name (Legal Business Name): SHARAT VALLURUPALLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE DEPARTMENT OF PSYCHIATRY
ALBANY NY
12208-3412
US

IV. Provider business mailing address

1489 LAVISTA RD NE STE A
ATLANTA GA
30324-3846
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3095
  • Fax:
Mailing address:
  • Phone: 678-400-3670
  • Fax: 916-252-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number63536
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number78332
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: