Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD40108 | TN |
NPI | 1508899246 |
---|---|
Provider Name | Suneetha S Nuthalapaty |
First Address | Morrison, TN 37357-7589 |
Second Address | Morrison, TN 37357-7589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 13/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114935 | HEALTHSPRING (01) | TN |
3334559 | (05) | TN |
4109701 | BLUE CROSS BLUE SHIELD (01) | TN |
I14935 | (02) | TN |