Provider Demographics
NPI:1134141211
Name:KOMARNENI, SREEDEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEDEVI
Middle Name:
Last Name:KOMARNENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 N ATHERTON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1544
Mailing Address - Country:US
Mailing Address - Phone:814-237-0567
Mailing Address - Fax:814-237-0569
Practice Address - Street 1:2214 N ATHERTON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1544
Practice Address - Country:US
Practice Address - Phone:814-237-0567
Practice Address - Fax:814-237-0569
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031425E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA229631NKAOtherPTAN