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General NPI Number Information
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NPI Number | 1710187687
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Entity Type | Individual
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Provider Name | AMULYA A NAGESWARA RAO MD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 200 FIRST STREET SW MAYO CLINIC
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City | ROCHESTER
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State | MN
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Zip | 55905
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Country | US
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Telephone | 507-284-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 200 FIRST STREET SW MAYO CLINIC
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City | ROCHESTER
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State | MN
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Zip | 55905
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Country | US
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Telephone | 507-284-2511
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 49916
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | MD038778
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 49916
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License Number State | MN
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