Provider Demographics
NPI:1255303863
Name:NUGURI, SHYLAJA (MD)
Entity Type:Individual
Prefix:
First Name:SHYLAJA
Middle Name:
Last Name:NUGURI
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 1:496 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1827
Mailing Address - Country:US
Mailing Address - Phone:859-288-2392
Mailing Address - Fax:859-721-3918
Practice Address - Street 1:496 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1827
Practice Address - Country:US
Practice Address - Phone:859-288-2425
Practice Address - Fax:859-899-5224
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52329208000000X
MO2000157497208000000X
SC37401208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1255303863Medicaid
MO1255303863Medicaid
MO1255303863OtherTRIWEST