Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125.071069 | IL |
Y | 207RG0300X | Geriatric Medicine | 281492 | MA |
NPI | 1144761438 |
---|---|
Provider Name | Shravya Budidi |
First Address | Boston, MA 02118-3549 |
Second Address | Boston, MA 02118-2642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2017 |
Last Update Date | 24/08/2020 |