Provider Demographics
NPI:1508899246
Name:NUTHALAPATY, SUNEETHA S (MD)
Entity Type:Individual
Prefix:
First Name:SUNEETHA
Middle Name:S
Last Name:NUTHALAPATY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUNEETHA
Other - Middle Name:S
Other - Last Name:KONALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6290 MANCHESTER HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-7589
Mailing Address - Country:US
Mailing Address - Phone:931-815-1616
Mailing Address - Fax:931-815-1717
Practice Address - Street 1:6290 MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-7589
Practice Address - Country:US
Practice Address - Phone:931-815-1616
Practice Address - Fax:931-815-1717
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40108204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN114935OtherHEALTHSPRING
TN3334559Medicaid
TN4109701OtherBLUE CROSS BLUE SHIELD
TN3334559Medicaid
TN3334559Medicare ID - Type Unspecified