Provider Demographics
NPI:1679869036
Name:DANDAMUDI, SAILAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAILAJA
Middle Name:
Last Name:DANDAMUDI
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 1:8471 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-5001
Mailing Address - Country:US
Mailing Address - Phone:832-709-2770
Mailing Address - Fax:832-924-0113
Practice Address - Street 1:8471 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-5001
Practice Address - Country:US
Practice Address - Phone:832-709-2770
Practice Address - Fax:832-924-0113
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT9370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program