Provider Demographics
NPI:1689293722
Name:TATAPUDY, PALLAVI (MD)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:
Last Name:TATAPUDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY-STONY BROOK HEALTH SCIENCE CTR/T-10 020
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8101
Mailing Address - Country:US
Mailing Address - Phone:631-444-3005
Mailing Address - Fax:
Practice Address - Street 1:SUNY-STONY BROOK HEALTH SCIENCE CTR/T-10 020
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8101
Practice Address - Country:US
Practice Address - Phone:631-444-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program