Provider Demographics
NPI:1629063789
Name:RACHAMALLU, SUDHEERA (MD)
Entity Type:Individual
Prefix:
First Name:SUDHEERA
Middle Name:
Last Name:RACHAMALLU
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 1:7777 HENNESSY BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-8648
Mailing Address - Fax:225-765-7898
Practice Address - Street 1:7777 HENNESSY BLVD STE 700
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-8648
Practice Address - Fax:225-765-7898
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2000962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09806288Medicaid
LA1629375Medicaid
LA4J776D497Medicare PIN
LA1629375Medicaid