Provider Demographics
NPI:1184916405
Name:NIDAMANURI, SRIGAYATRI D BOLLEPALLI (MD)
Entity type:Individual
Prefix:DR
First Name:SRIGAYATRI
Middle Name:D BOLLEPALLI
Last Name:NIDAMANURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SRIGAYATRI
Other - Middle Name:D
Other - Last Name:BOLLEPALLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2653 W GUADALUPE RD
Mailing Address - Street 2:AZTECH RADIOLOGY, STE #100
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7200
Mailing Address - Country:US
Mailing Address - Phone:480-455-1860
Mailing Address - Fax:
Practice Address - Street 1:2653 W GUADALUPE RD
Practice Address - Street 2:AZTECH RADIOLOGY, STE #100
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7200
Practice Address - Country:US
Practice Address - Phone:480-455-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ425702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ615476Medicaid
AZZ145586Medicare PIN