Provider Demographics
NPI:1356128060
Name:NAGULAPALLY, SHYAM PRASAD (MPT)
Entity type:Individual
Prefix:
First Name:SHYAM PRASAD
Middle Name:
Last Name:NAGULAPALLY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 60TH DR FL 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5450
Mailing Address - Country:US
Mailing Address - Phone:951-772-4712
Mailing Address - Fax:
Practice Address - Street 1:99 MOORE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3329
Practice Address - Country:US
Practice Address - Phone:718-387-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist