Provider Demographics
NPI:1851894869
Name:NAGURLA, SHRAVYA RAO
Entity Type:Individual
Prefix:
First Name:SHRAVYA
Middle Name:RAO
Last Name:NAGURLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 FOXTRAIL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9089
Mailing Address - Country:US
Mailing Address - Phone:970-237-7588
Mailing Address - Fax:970-237-7587
Practice Address - Street 1:1625 FOXTRAIL DR STE 200
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9089
Practice Address - Country:US
Practice Address - Phone:970-237-7588
Practice Address - Fax:970-237-7587
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071248207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program