Provider Demographics
NPI:1316920101
Name:LULLA, KIRAN SUNIL (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:SUNIL
Last Name:LULLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANJANA
Other - Middle Name:DWARKADAS
Other - Last Name:MEHRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:720 WELLESLEY ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1000
Mailing Address - Country:US
Mailing Address - Phone:781-237-5687
Mailing Address - Fax:617-636-4852
Practice Address - Street 1:219 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3105
Practice Address - Country:US
Practice Address - Phone:781-434-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2173222084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry