Provider Demographics
NPI:1508849068
Name:CHALASANI, SIRISHA (MD)
Entity type:Individual
Prefix:
First Name:SIRISHA
Middle Name:
Last Name:CHALASANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640573
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0573
Mailing Address - Country:US
Mailing Address - Phone:352-746-1558
Mailing Address - Fax:352-746-3838
Practice Address - Street 1:20021 SW 111TH PL
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-4786
Practice Address - Country:US
Practice Address - Phone:352-465-1199
Practice Address - Fax:352-465-1207
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME10152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000128400Medicaid
FLP00672401OtherRR MEDICARE
FLBD990ZMedicare PIN