Provider Demographics
NPI:1407210974
Name:DR SREEDEVI KOMARNENI CHOICES LLC
Entity Type:Organization
Organization Name:DR SREEDEVI KOMARNENI CHOICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SREEDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMARNENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-237-0567
Mailing Address - Street 1:2214 N ATHERTON ST
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-031425E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty