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General NPI Number Information
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NPI Number | 1053874313
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Entity Type | Individual
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Provider Name | PRIYAL UPADHYAY MD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 2530 BERT KOUNS INDUSTRIAL LOOP STE 115
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City | SHREVEPORT
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State | LA
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Zip | 71118-3153
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Country | US
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Telephone | 318-212-4824
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Fax | 318-212-5994
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Provider Business Mailing Address
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Address Line | 2530 BERT KOUNS INDUSTRIAL LOOP STE 115
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City | SHREVEPORT
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State | LA
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Zip | 71118-3153
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Country | US
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Telephone | 318-212-4824
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Fax | 318-212-5994
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 330541
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License Number State | LA
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