Provider Demographics
NPI:1508070152
Name:NANDALUR, SIRISHA R (MD)
Entity Type:Individual
Prefix:
First Name:SIRISHA
Middle Name:R
Last Name:NANDALUR
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-5000
Practice Address - Fax:248-964-6158
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-10-20
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Provider Licenses
StateLicense IDTaxonomies
MI43010837052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology