Provider Demographics
NPI:1952591059
Name:MADDUKURI, SRIREKHA (MD)
Entity Type:Individual
Prefix:
First Name:SRIREKHA
Middle Name:
Last Name:MADDUKURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRIREKHA
Other - Middle Name:
Other - Last Name:JAKKAMPUDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1305 AIRPORT FWY
Mailing Address - Street 2:STE 205
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6605
Mailing Address - Country:US
Mailing Address - Phone:817-267-6290
Mailing Address - Fax:817-267-0950
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:STE 205
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:817-267-6290
Practice Address - Fax:817-267-0950
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2315892084N0400X
TXP31942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000606301Medicare PIN