Provider Demographics
NPI:1497744841
Name:NUKALAPATI, PRASUNA R
Entity Type:Individual
Prefix:DR
First Name:PRASUNA
Middle Name:R
Last Name:NUKALAPATI
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 1:4673 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5623
Mailing Address - Country:US
Mailing Address - Phone:718-365-5413
Mailing Address - Fax:718-364-6716
Practice Address - Street 1:4673 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5623
Practice Address - Country:US
Practice Address - Phone:718-365-5413
Practice Address - Fax:718-364-6716
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00237009Medicaid