Provider Demographics
NPI:1346648144
Name:BULUSU, SHAILAJA
Entity Type:Individual
Prefix:
First Name:SHAILAJA
Middle Name:
Last Name:BULUSU
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 1:4341 PIEDMONT AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4792
Mailing Address - Country:US
Mailing Address - Phone:510-547-1630
Mailing Address - Fax:510-923-1944
Practice Address - Street 1:THREE EMBARCADERO CENTER
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111
Practice Address - Country:US
Practice Address - Phone:415-495-2225
Practice Address - Fax:415-494-2228
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist