Healthcare Provider Details

I. General information

NPI: 1194519744
Provider Name (Legal Business Name): VIKHYATHI PALLERLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3876
US

IV. Provider business mailing address

300 EDWARDS ST APT 4GW
ROSLYN HEIGHTS NY
11577-1172
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-2303
  • Fax: 516-562-2860
Mailing address:
  • Phone:
  • 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: