Provider Demographics
NPI:1205842010
Name:YADALLA, SANCHITA (MD, FACOG)
Entity Type:Individual
Prefix:
First Name:SANCHITA
Middle Name:
Last Name:YADALLA
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-2491
Mailing Address - Fax:432-640-2493
Practice Address - Street 1:375 N SAM HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5051
Practice Address - Country:US
Practice Address - Phone:432-640-2491
Practice Address - Fax:432-640-2493
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436010207V00000X
NY2349431207V00000X
TXQ5304207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528049001OtherBC/BS WNY
NY050228000057OtherFIDELIS
NYP010234943OtherMUNROE PLAN
NY00027018301OtherUNIVERA
NY7698616OtherAETNA
NY000528049001OtherBC/BS OF WNY
NYP020234943OtherBC/BS ROCHESTER
NY159062CKOtherPREFERRED CARE
NY02634797Medicaid
NY0791301OtherINDEPENDENT HEALTH
PA1023261680001Medicaid
NYP010234943OtherBLUE CHOICE
NYP010234943OtherBLUE CHOICE
NY050228000057OtherFIDELIS
NY0791301OtherINDEPENDENT HEALTH