Provider Demographics
NPI:1285894543
Name:KURUVILLA, NANDITA (DO)
Entity type:Individual
Prefix:DR
First Name:NANDITA
Middle Name:
Last Name:KURUVILLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 E BAYAUD AVE
Mailing Address - Street 2:APT# 905A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2906
Mailing Address - Country:US
Mailing Address - Phone:516-455-8368
Mailing Address - Fax:
Practice Address - Street 1:3329 E BAYAUD AVE
Practice Address - Street 2:APT# 905A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2906
Practice Address - Country:US
Practice Address - Phone:516-455-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics