Provider Demographics
NPI:1184930331
Name:SREEDEVI, MINI (MD)
Entity type:Individual
Prefix:DR
First Name:MINI
Middle Name:
Last Name:SREEDEVI
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 1:2821 E PRESIDENT GEORGE BUSH HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4277
Mailing Address - Country:US
Mailing Address - Phone:972-907-1280
Mailing Address - Fax:972-907-1290
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 207
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082
Practice Address - Country:US
Practice Address - Phone:972-907-1280
Practice Address - Fax:972-907-1290
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124963207V00000X
TXQ9743207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124963Medicaid
IL356255Medicare PIN