Provider Demographics
NPI:1750630463
Name:GUDURU, NIKHILA (MS)
Entity Type:Individual
Prefix:MRS
First Name:NIKHILA
Middle Name:
Last Name:GUDURU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 CENTRE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3735
Mailing Address - Country:US
Mailing Address - Phone:862-377-2157
Mailing Address - Fax:
Practice Address - Street 1:5030 BROADWAY STE 809
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1666
Practice Address - Country:US
Practice Address - Phone:212-304-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist