Provider Demographics
NPI:1396831582
Name:UDAYAMURTHY, YASODARA B (MD)
Entity Type:Individual
Prefix:
First Name:YASODARA
Middle Name:B
Last Name:UDAYAMURTHY
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 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:15655 CYPRESSWOODS MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1471
Practice Address - Country:US
Practice Address - Phone:713-442-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125686902Medicaid
TX125686907Medicaid
TX125686905Medicaid
TX125686906Medicaid
TX8730N0Medicare PIN
TX125686905Medicaid
TX8B6664Medicare PIN
TX125686907Medicaid