Healthcare Provider Details

I. General information

NPI: 1326807231
Provider Name (Legal Business Name): KEERTI PRIYA VAJRALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 08/04/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE ROAD BALCONY SUITE 5
GREENVILLE SC
29605
US

IV. Provider business mailing address

701 GROVE ROAD BALCONY SUITE 5
GREENVILLE SC
29605
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7895
  • Fax:
Mailing address:
  • Phone: 864-455-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL94573
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: