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General NPI Number Information
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NPI Number | 1811793722
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Entity Type | Individual
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Provider Name | MS. SHYAMALA NAGENDRAN NAIDU
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Gender | Female
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 635 ALBANY STREET
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 617-358-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 714 MASSACHUSETTS AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02139
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Country | US
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Telephone | 617-868-9400
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN10001114
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License Number State | MA
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