Provider Demographics
NPI:1043605330
Name:DAVULURI, MEENAKSHI (MD)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:DAVULURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST # 94
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:718-230-7788
Mailing Address - Fax:718-230-8017
Practice Address - Street 1:38 6TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4187
Practice Address - Country:US
Practice Address - Phone:718-230-7788
Practice Address - Fax:718-230-8017
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY306104208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program