Provider Demographics
NPI:1942663497
Name:DENDULURI, MEENAKSHI SHIVARAM (MD)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:SHIVARAM
Last Name:DENDULURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEENAKSHI
Other - Middle Name:RANJANI
Other - Last Name:SHIVARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 QUARRY RD
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1419
Mailing Address - Country:US
Mailing Address - Phone:650-725-5591
Mailing Address - Fax:
Practice Address - Street 1:401 QUARRY ROAD
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-1419
Practice Address - Country:US
Practice Address - Phone:650-725-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1518432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry