MEDICARE: SPANDANA NALLAPATI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0006X	Developmental - Behavioral Pediatrics Physician	25MA09741800	NJ
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	MD479162	PA
3	2080P0006X	Developmental - Behavioral Pediatrics Physician	307771	NY

General Provider Information

NPI Number	:	1295107183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPANDANA NALLAPATI MD

Provider Business Mailing Address
First Line	:	3495 US HIGHWAY 1 STE 34
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5933
Country	:	US
Telephone Number	:	640-225-3072
Fax Number	:	609-228-6610

Provider Business Practice Location Address
First Line	:	3495 US HIGHWAY 1 STE 34
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5933
Country	:	US
Telephone Number	:	640-225-3072
Fax Number	:	609-228-6610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	02/10/2026

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