Provider Demographics
NPI:1932432580
Name:NALLA, SRIJAYA SOUJANYA (MD)
Entity Type:Individual
Prefix:
First Name:SRIJAYA SOUJANYA
Middle Name:
Last Name:NALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3182
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:2100 KEYSTONE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1129
Practice Address - Country:US
Practice Address - Phone:610-394-4710
Practice Address - Fax:610-394-4721
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194769207V00000X
PAMD449133207V00000X
CODR.0056318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23370050Medicaid