Provider Demographics
NPI:1417202201
Name:VAJJALA, SRIHARSHA (MD)
Entity Type:Individual
Prefix:
First Name:SRIHARSHA
Middle Name:
Last Name:VAJJALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 E HARTFORD DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7205
Mailing Address - Country:US
Mailing Address - Phone:480-745-3547
Mailing Address - Fax:480-745-3548
Practice Address - Street 1:8330 E HARTFORD DR
Practice Address - Street 2:STE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-745-3547
Practice Address - Fax:480-745-3548
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ52075207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ149601Medicaid