Healthcare Provider Details

I. General information

NPI: 1447782925
Provider Name (Legal Business Name): DR. LEELA SUBHASHINI CHOUDARY ALLURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DR DB TODD JR BLVD
NASHVILLE TN
37208-3501
US

IV. Provider business mailing address

1005 DR DB TODD JR BLVD
NASHVILLE TN
37208-3501
US

V. Phone/Fax

Practice location:
  • Phone: 469-406-6799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11766
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: