Provider Demographics
NPI:1093960544
Name:PASUPULETI, LAAVANYA (DO)
Entity Type:Individual
Prefix:DR
First Name:LAAVANYA
Middle Name:
Last Name:PASUPULETI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 RUSTIC WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9011
Mailing Address - Country:US
Mailing Address - Phone:732-303-0484
Mailing Address - Fax:
Practice Address - Street 1:1501 LEHIGH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3880
Practice Address - Country:US
Practice Address - Phone:610-628-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATO12549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine