Provider Demographics
NPI:1164789533
Name:PULUSANI, VAISHNAVI REDDY (MD)
Entity Type:Individual
Prefix:
First Name:VAISHNAVI
Middle Name:REDDY
Last Name:PULUSANI
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 1:6401 POPLAR AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4810
Mailing Address - Country:US
Mailing Address - Phone:901-888-8770
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE STE 190
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-888-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54064207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030625Medicaid
MS06977094Medicaid
AR221435001Medicaid