Provider Demographics
NPI:1780689919
Name:JUVVADI, SRIDEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIDEVI
Middle Name:
Last Name:JUVVADI
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061
Practice Address - Country:US
Practice Address - Phone:972-256-3537
Practice Address - Fax:972-255-7916
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4997207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01154875OtherRAILROAD MEDICARE
TX157309904Medicaid
TX157309903Medicaid
TXP01154875OtherRAILROAD MEDICARE
TX157309904Medicaid
TX8F2085Medicare PIN