MEDICARE: AYU CLINICAL RESEARCH LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1881358166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AYU CLINICAL RESEARCH LLC

Provider Business Mailing Address
First Line	:	5108 AUSTIN HEALEY DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5817
Country	:	US
Telephone Number	:	804-615-8643
Fax Number	:

Provider Business Practice Location Address
First Line	:	5108 AUSTIN HEALEY DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5817
Country	:	US
Telephone Number	:	804-615-8643
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LALITA POTLURI
Credential	:
Telephone Number	:	804-615-8643

Provider Enumeration Date	:	10/23/2021
Last Update Date	:	10/23/2021

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