Provider Demographics
NPI:1750471769
Name:YALAMANCHILI, SUSHMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:
Last Name:YALAMANCHILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSHMA
Other - Middle Name:
Other - Last Name:CHILUKURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2855 GRAMERCY ST # 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1697
Mailing Address - Country:US
Mailing Address - Phone:713-558-8728
Mailing Address - Fax:
Practice Address - Street 1:915 GESSNER RD STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2534
Practice Address - Country:US
Practice Address - Phone:713-467-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229817207W00000X
TX42964207W00000X
TXP8003207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212034704Medicaid
TXP01063000OtherRAILROAD MEDICARE
TXP00859676OtherMEDICARE RAILROAD
TX212034701Medicaid
TX212034702Medicaid
TX1750471769OtherBLUE CROSS BLUE SHIELD
TXP00859676OtherMEDICARE RAILROAD