Healthcare Provider Details

I. General information

NPI: 1386867182
Provider Name (Legal Business Name): SARAYU BALU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 WASHINGTON HWY
MORRISVILLE VT
05661-8652
US

IV. Provider business mailing address

PO BOX 608 RYDER BROOK PEDIATRICS
MORRISVILLE VT
05661-0608
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-7337
  • Fax: 802-888-7398
Mailing address:
  • Phone: 802-888-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0006455
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042.0006455
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: