Provider Demographics
NPI:1043663370
Name:SORAPURU, TAMMY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:SORAPURU
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19835 S MANHATTAN LN
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3033
Mailing Address - Country:US
Mailing Address - Phone:504-487-7840
Mailing Address - Fax:
Practice Address - Street 1:75 DOMINICAN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3400
Practice Address - Country:US
Practice Address - Phone:985-224-2998
Practice Address - Fax:985-224-2995
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health