Provider Demographics
NPI:1467847764
Name:BHADURI, ANURADHA (PSYD)
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:BHADURI
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MARCO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2540
Mailing Address - Country:US
Mailing Address - Phone:919-636-5240
Mailing Address - Fax:
Practice Address - Street 1:1101 MARCO DR STE 200
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2540
Practice Address - Country:US
Practice Address - Phone:919-636-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.005380103T00000X
NC6622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist