Provider Demographics
NPI:1558397133
Name:NELLURI, SATYA NARAYANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SATYA
Middle Name:NARAYANA
Last Name:NELLURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SATYANARAYANA
Other - Middle Name:
Other - Last Name:NELLURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12505 E. 16TH AVE., AIP2, 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-724-0922
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:303-724-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26494207RC0000X
MI4301075093207RC0000X, 207RI0011X, 207UN0901X
CODR.0059661207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47066229001Medicaid
MI4499569Medicaid
MIP105496OtherBLUECARENETWORK
MI0Q26305006OtherBLUECROSSBLUESHIELD OF MI
NE47066229001Medicaid
MIH10591Medicare UPIN
MI0Q26305006Medicare PIN
MIP105496OtherBLUECARENETWORK