Healthcare Provider Details

I. General information

NPI: 1245657683
Provider Name (Legal Business Name): NEEHARIKA METTUPALLI M.BBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 RED BLUFF RD
PASADENA TX
77503-3606
US

IV. Provider business mailing address

1643 NW 136TH AVE STE 100
SUNRISE FL
33323-2857
US

V. Phone/Fax

Practice location:
  • Phone: 713-477-7877
  • Fax:
Mailing address:
  • Phone: 954-835-2841
  • Fax: 865-560-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU5462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: