Individual
JYOTHI PRAVALLIKA EDUPUGANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
19485 OLD JETTON RD STE 100, CORNELIUS, NC 28031-6583
(704) 316-5170
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
RTL25-1107
NC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/25/2025
Last updated
06/16/2025
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