Provider Demographics
NPI:1639599814
Name:TALLAPUREDDY, PRAVEENA K (MD)
Entity Type:Individual
Prefix:
First Name:PRAVEENA
Middle Name:K
Last Name:TALLAPUREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRAVEENA
Other - Middle Name:K
Other - Last Name:LAKIREDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:425 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1053
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:512-509-0285
Is Sole Proprietor?:No
Enumeration Date:2014-04-26
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050870208000000X
TXR2987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics