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General NPI Number Information
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NPI Number | 1366466963
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Entity Type | Organization
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Legal Business Name | NALLURI PLASTIC SURGERY, INC.
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 6118 S TAMIAMI TRAIL
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City | SARASOTA
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State | FL
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Zip | 34231
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Country | US
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Telephone | 941-752-7842
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Fax | 941-955-9105
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Provider Business Mailing Address
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Address Line | 6118 S TAMIAMI TRAIL
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City | SARASOTA
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State | FL
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Zip | 34231
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Country | US
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Telephone | 941-752-7842
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Fax | 941-955-9105
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJA NALLURI
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Credential | M.D.
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Telephone | 941-752-7842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME84444
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License Number State | FL
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