Organization
WALMART HEALTH NY TELEMEDICINE PLLC
Active
Other names
Pegus Telemedicine PLLC, Pulluru Telemedicine PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SHEN (OWNER)
(512) 779-7276
Entity
Organization
Contact information
Practice address
702 SW 8TH ST # MS 0215, BENTONVILLE, AR 72716-6209
(479) 258-2080
Mailing address
702 SW 8TH ST # MS 0215, BENTONVILLE, AR 72716-6209
(479) 258-2080
Taxonomy
Speciality
Code
Description
License number
State
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
Primary
—
—
Other
Enumeration date
04/26/2022
Last updated
02/13/2024
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