Provider Demographics
NPI:1326660630
Name:NALLAN CHAKRAVARTHULA, PREETI (MBBS)
Entity Type:Individual
Prefix:MS
First Name:PREETI
Middle Name:
Last Name:NALLAN CHAKRAVARTHULA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W 139 STREET
Mailing Address - Street 2:APT 8B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037
Mailing Address - Country:US
Mailing Address - Phone:347-901-0482
Mailing Address - Fax:
Practice Address - Street 1:70 W 139 STREET
Practice Address - Street 2:APT 8B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:347-901-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2024-03-12
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2024-03-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program