Provider Demographics
NPI:1699961938
Name:NULU, SHANTI (MD)
Entity type:Individual
Prefix:DR
First Name:SHANTI
Middle Name:
Last Name:NULU
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 1:301 SETON PARKWAY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665
Mailing Address - Country:US
Mailing Address - Phone:512-324-4812
Mailing Address - Fax:512-324-4728
Practice Address - Street 1:301 SETON PKWY STE 302
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8003
Practice Address - Country:US
Practice Address - Phone:512-324-4812
Practice Address - Fax:512-324-4728
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6251207RC0000X
NY250928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX580601YL9XOtherMEDICARE
TX8GV735OtherBCBS
TX580601YMGJOtherMEDICARE