Provider Demographics
NPI:1578759387
Name:NALLURI, SHOBHA RANI (MD)
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:RANI
Last Name:NALLURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7202 GLEN FOREST DR
Mailing Address - Street 2:C/O VIRGINIA CANCER INSTITUTE SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-673-0134
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:4730 PUDDLEDOCK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1237
Practice Address - Country:US
Practice Address - Phone:804-452-3850
Practice Address - Fax:804-541-7585
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250289207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01120OtherMEDICARE GROUP PTAN
VAVV2831BMedicare PIN