Provider Demographics
NPI:1730142944
Name:CHALLAPALLI, VISHNU (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHNU
Middle Name:
Last Name:CHALLAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LACE PT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1703
Mailing Address - Country:US
Mailing Address - Phone:585-203-7308
Mailing Address - Fax:
Practice Address - Street 1:3 LACE PT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-1703
Practice Address - Country:US
Practice Address - Phone:585-203-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ87022084P0804X, 273R00000X
NY182242-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007632375OtherAETNA
102641EUOtherPREFERRED CARE
NY01579840Medicaid
P010182242OtherBCBS
NY01579840Medicaid
BB2124Medicare ID - Type Unspecified
BB2124Medicare ID - Type Unspecified