Provider Demographics
NPI:1649343013
Name:TALATI, SHRADDHA (MD)
Entity type:Individual
Prefix:
First Name:SHRADDHA
Middle Name:
Last Name:TALATI
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 1:341 WHEATFIELD DRIVE, STE. 210
Mailing Address - Street 2:MEDICAL PLAZA I
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182
Mailing Address - Country:US
Mailing Address - Phone:972-270-8777
Mailing Address - Fax:972-270-7554
Practice Address - Street 1:341 WHEATFIELD DRIVE, STE. 210
Practice Address - Street 2:MEDICAL PLAZA I
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182
Practice Address - Country:US
Practice Address - Phone:972-270-8777
Practice Address - Fax:972-270-7554
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0601207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034252901Medicaid
TX034252901Medicaid