Provider Demographics
NPI:1639388689
Name:SHREEDHARA VASUDHA, MEERA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:
Last Name:SHREEDHARA VASUDHA
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:4215 JOE RAMSEY BLVD E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:903-408-5112
Practice Address - Fax:903-408-5124
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5507207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194503204Medicaid
TX194503203Medicaid
TX194503201Medicaid
TX194503274Medicaid
TX194503202Medicaid
TXP00745455OtherRAILROAD MEDICARE
TX8K0614Medicare PIN
TX194503202Medicaid
TX194503201Medicaid
TX194503203Medicaid