Provider Demographics
NPI:1851595441
Name:TALLAVAJHULA, SUDHA SUDHAKAR (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:SUDHAKAR
Last Name:TALLAVAJHULA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 7.044
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6028
Mailing Address - Fax:713-797-7748
Practice Address - Street 1:1333 MOURSUND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3405
Practice Address - Country:US
Practice Address - Phone:713-797-7742
Practice Address - Fax:713-797-7748
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN47772084N0400X, 2084E0001X, 2084S0012X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine