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General NPI Number Information
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NPI Number | 1194872713
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Entity Type | Individual
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Provider Name | JYOTHI DYAVANAPALLI GUDLA M.D
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 4808 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-3613
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Country | US
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Telephone | 330-622-0207
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Fax | 330-832-3499
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Provider Business Mailing Address
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Address Line | 4808 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-3613
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Country | US
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Telephone | 330-460-4115
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Fax | 330-832-3499
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35-083145
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-083145
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 35.083145
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.083145
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License Number State | OH
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