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General NPI Number Information
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NPI Number | 1396056875
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Entity Type | Individual
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Provider Name | SHREYA MANIAR NAGULA MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 37 RESEARCH WAY STONY BROOK CHILDRENS SERVICES
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3465
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Country | US
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Telephone | 631-444-2730
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Fax |
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Provider Business Mailing Address
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Address Line | STONY BROOK CHILDRENS SERVICES UFPC HSC LEVEL 11 ROOM 080
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-444-2730
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Fax |
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 252478
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License Number State | NY
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