Provider Demographics
NPI:1386867182
Name:BALU, SARAYU (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAYU
Middle Name:
Last Name:BALU
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:PO BOX 608
Mailing Address - Street 2:RYDER BROOK PEDIATRICS
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0608
Mailing Address - Country:US
Mailing Address - Phone:802-888-2448
Mailing Address - Fax:
Practice Address - Street 1:609 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8652
Practice Address - Country:US
Practice Address - Phone:802-888-7337
Practice Address - Fax:802-888-7398
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006455208000000X
VT042.0006455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005114OtherPROVIDER NUMBER FOR OTHER
VT0005114Medicaid