Provider Demographics
NPI:1578558904
Name:DEVULAPALLI, SITA MAHALAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:SITA
Middle Name:MAHALAKSHMI
Last Name:DEVULAPALLI
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 1:903 WALNUT HILL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5062
Mailing Address - Country:US
Mailing Address - Phone:903-234-9500
Mailing Address - Fax:903-234-2360
Practice Address - Street 1:903 WALNUT HILL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5062
Practice Address - Country:US
Practice Address - Phone:903-234-9500
Practice Address - Fax:903-234-2360
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0012CAOtherBCBSTX PROVIDER ID
TXG55868Medicare UPIN
TX0012CAMedicare ID - Type UnspecifiedMEDICARE