Provider Demographics
NPI:1760511182
Name:NELLORI, PRIYANKA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:NELLORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRIYANKA
Other - Middle Name:
Other - Last Name:NELLORI VAKULABARANAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 MEMORIAL PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2771
Mailing Address - Country:US
Mailing Address - Phone:908-847-6722
Mailing Address - Fax:833-541-5799
Practice Address - Street 1:755 MEMORIAL PKWY STE 302
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2771
Practice Address - Country:US
Practice Address - Phone:908-847-6722
Practice Address - Fax:833-541-5799
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6474858-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063570Medicare PIN