MEDICARE: SHYAM SUNDER PRASAD VUYYURU 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	2084P0800X	Psychiatry Physician	31102	TN

General Provider Information

NPI Number	:	1568430726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYAM SUNDER PRASAD VUYYURU MD

Provider Business Mailing Address
First Line	:	PO BOX 1999
Second Line	:
City	:	LOUISVILLE
State	:	TN
Zip	:	37777
Country	:	US
Telephone Number	:	865-970-1295
Fax Number	:	865-380-1461

Provider Business Practice Location Address
First Line	:	2347 JONES BEND RD
Second Line	:
City	:	LOUISVILLE
State	:	TN
Zip	:	37777
Country	:	US
Telephone Number	:	865-970-9800
Fax Number	:	865-380-1461

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/08/2007

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