Provider Demographics
NPI:1609981174
Name:EDALUR, SHYLASHREE CHIKKAMUNIYAPPA (MD)
Entity Type:Individual
Prefix:
First Name:SHYLASHREE
Middle Name:CHIKKAMUNIYAPPA
Last Name:EDALUR
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 1:1026 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-6229
Mailing Address - Country:US
Mailing Address - Phone:903-239-3862
Mailing Address - Fax:
Practice Address - Street 1:1026 RIVERWOOD DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6229
Practice Address - Country:US
Practice Address - Phone:903-239-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3188207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3188OtherPHYSICIAN PERMIT