Provider Demographics
NPI:1669483814
Name:MADISETTY, SASI (MD)
Entity Type:Individual
Prefix:MRS
First Name:SASI
Middle Name:
Last Name:MADISETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SASIREKHA
Other - Middle Name:
Other - Last Name:GUDAVALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:304 S. 22ND ST
Mailing Address - Street 2:CENTRAL COUNTIES MH MR
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-7003
Mailing Address - Country:US
Mailing Address - Phone:254-298-7000
Mailing Address - Fax:254-298-7003
Practice Address - Street 1:304 S. 22ND ST
Practice Address - Street 2:CENTRAL COUNTIES MH MR
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7003
Practice Address - Country:US
Practice Address - Phone:254-298-7000
Practice Address - Fax:254-298-7003
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ75632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2084P0804XMedicaid