Healthcare Provider Details

I. General information

NPI: 1841654886
Provider Name (Legal Business Name): NOVUS HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 MUNSON ST NW
CANTON OH
44718
US

IV. Provider business mailing address

4808 MUNSON ST NW
CANTON OH
44718-3613
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-8666
  • Fax: 330-832-3499
Mailing address:
  • Phone: 330-830-8666
  • Fax: 330-832-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JYOTHI DYAVANAPALLI GUDLA
Title or Position: PRESIDENT
Credential: MD
Phone: 330-830-8666