Provider Demographics
NPI:1477646560
Name:NAGIREDDY, SHANTI S (MD)
Entity Type:Individual
Prefix:
First Name:SHANTI
Middle Name:S
Last Name:NAGIREDDY
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:901 7TH AVE STE 2200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2722
Practice Address - Country:US
Practice Address - Phone:682-885-1050
Practice Address - Fax:682-885-7572
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM30392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherMEDICARE GROUP PIN
TX137345810OtherCSHCN GROUP TPI
1750369203OtherGRP NPI NUMBER
TX140442852OtherMEDICAID GROUP TPI
TX184110803Medicaid
TX184110804OtherCSHCN INDIVIDUAL TPI
TX184110804OtherCSHCN INDIVIDUAL TPI
TX8L13525Medicare PIN