Provider Demographics
NPI:1164202974
Name:VUPPALA, SIMRAN
Entity Type:Individual
Prefix:
First Name:SIMRAN
Middle Name:
Last Name:VUPPALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5018
Mailing Address - Country:US
Mailing Address - Phone:845-689-4476
Mailing Address - Fax:
Practice Address - Street 1:1240 SE MAYNARD RD OFC CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6929
Practice Address - Country:US
Practice Address - Phone:845-689-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional