Provider Demographics
NPI:1255226601
Name:DUVVURI, PALLAVI AISHWARYA
Entity type:Individual
Prefix:
First Name:PALLAVI
Middle Name:AISHWARYA
Last Name:DUVVURI
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 1:25 LILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1712
Mailing Address - Country:US
Mailing Address - Phone:631-561-1176
Mailing Address - Fax:
Practice Address - Street 1:25 LILLIAN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1712
Practice Address - Country:US
Practice Address - Phone:631-561-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty