Individual provider Active NPI

Shreya Nerli, DDS

  • Dentist
  • Clovis, NM
National Provider Identifier
1104554203
Registry record updated Aug 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD5685 Issued in NM
Practice address
4017 N Prince St
Clovis, NM 88101-9705
Phone
(575) 762-2757
NPI assigned
Aug 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD5685 NM Primary

Addresses

Primary practice location

4017 N Prince St
Clovis, NM 88101-9705

Mailing address

4017 N Prince St
Clovis, NM 88101-9705
Phone (575) 762-2757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DD5685NMMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Familia Dentalclovis LLC CurrentSince Aug 14, 2022 Accepting new patients

Locations

4017 N Prince St
Clovis, NM 88101
Phone (575) 762-2757

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1104554203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4017 N PRINCE ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019705",
            "telephone_number": "575-762-2757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4017 N PRINCE ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019705",
            "telephone_number": "575-762-2757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NERLI",
        "first_name": "SHREYA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-08",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD5685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.