Provider Demographics
NPI:1396242954
Name:NANDAMURU, PRAVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:NANDAMURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:1 CHILDRENS WAY # 512-17
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1893
Practice Address - Fax:501-364-2865
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021022245208000000X
ARE-16579208000000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine