Provider Demographics
NPI:1235293952
Name:CHAGANTI, SRIDEVI
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:CHAGANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 FRANKFORD RD
Mailing Address - Street 2:326
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6459
Mailing Address - Country:US
Mailing Address - Phone:972-398-9638
Mailing Address - Fax:
Practice Address - Street 1:7575 FRANKFORD RD
Practice Address - Street 2:# 326
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6459
Practice Address - Country:US
Practice Address - Phone:972-398-9638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine