Provider Demographics
NPI:1366625683
Name:GODEY, SREEDEVI (MD)
Entity Type:Individual
Prefix:
First Name:SREEDEVI
Middle Name:
Last Name:GODEY
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 1:840 W CLEMENTS
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-640-4860
Mailing Address - Fax:432-640-4864
Practice Address - Street 1:840 W CLEMENTS
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-640-4860
Practice Address - Fax:432-640-4864
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB124139Medicare PIN