Provider Demographics
NPI:1205049376
Name:VENIGALLA, SRIDEVI (MD)
Entity type:Individual
Prefix:DR
First Name:SRIDEVI
Middle Name:
Last Name:VENIGALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-377-8100
Mailing Address - Fax:408-377-3044
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-377-8100
Practice Address - Fax:408-377-3044
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1037622080N0001X
ORMD 286692080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine