Provider Demographics
NPI:1578357547
Name:SUPPALA, PRAVEENA (MBBS)
Entity type:Individual
Prefix:DR
First Name:PRAVEENA
Middle Name:
Last Name:SUPPALA
Suffix:
Gender:
Credentials:MBBS
Other - Prefix:DR
Other - First Name:PRAVEENA
Other - Middle Name:
Other - Last Name:BATTU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:19501 CARAWAY PL
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-9239
Mailing Address - Country:US
Mailing Address - Phone:669-286-5880
Mailing Address - Fax:
Practice Address - Street 1:1400 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1554
Practice Address - Country:US
Practice Address - Phone:605-333-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program