Provider Demographics
NPI:1831978394
Name:BODAVULA, SREEVANI (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SREEVANI
Middle Name:
Last Name:BODAVULA
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6448 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5943
Mailing Address - Country:US
Mailing Address - Phone:972-216-8500
Mailing Address - Fax:972-216-8521
Practice Address - Street 1:6448 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5943
Practice Address - Country:US
Practice Address - Phone:972-216-8500
Practice Address - Fax:972-216-8521
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily