# WALMART HEALTH NY TELEMEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pegus Telemedicine PLLC, Pulluru Telemedicine PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417691353
- **Authorized official:** MARK SHEN (OWNER)
- **Authorized official phone:** (512) 779-7276

## Contact information

- **Practice address:** 702 SW 8TH ST \# MS 0215, BENTONVILLE, AR 72716-6209
- **Practice address phone:** (479) 258-2080
- **Mailing address:** 702 SW 8TH ST \# MS 0215, BENTONVILLE, AR 72716-6209
- **Mailing address phone:** (479) 258-2080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | — | — |
| 103T00000X | Psychologist | — | — | — |
| 104100000X | Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/26/2022
- **Last updated:** 02/13/2024