MEDICARE: LAKSHMI LAVANYA NANDYALA ND

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	175F00000X	Naturopath	131364	AZ

General Provider Information

NPI Number	:	1619316411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSHMI LAVANYA NANDYALA ND

Provider Business Mailing Address
First Line	:	633 E RAY RD STE 133
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4206
Country	:	US
Telephone Number	:	804-986-6378
Fax Number	:	480-658-0628

Provider Business Practice Location Address
First Line	:	633 E RAY RD STE 133
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4206
Country	:	US
Telephone Number	:	804-986-6378
Fax Number	:

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	02/11/2025

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