Provider Demographics
NPI:1730364597
Name:TALLURI, SUNITHA
Entity type:Individual
Prefix:MRS
First Name:SUNITHA
Middle Name:
Last Name:TALLURI
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 1:173 MARCUS GARVEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1408
Mailing Address - Country:US
Mailing Address - Phone:718-249-0670
Mailing Address - Fax:
Practice Address - Street 1:173 MARCUS GARVEY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-1408
Practice Address - Country:US
Practice Address - Phone:718-249-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03270300183500000X
FLPS38302183500000X
NY055249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02778825Medicaid