Provider Demographics
NPI:1114651858
Name:VULASALA, SAI SWARUPA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SAI SWARUPA
Middle Name:REDDY
Last Name:VULASALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 WEST 8 TH STREET
Mailing Address - Street 2:2ND FLOOR CLINICAL CENTER, C90
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:432-999-1704
Mailing Address - Fax:
Practice Address - Street 1:655 WEST 8 TH STREET
Practice Address - Street 2:C90, 2ND FLOOR CLINICAL CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRTL22-0203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine