1245811215 NPI number — SHIVANI VENKATASRI PALAKODATY DO

Table of content: SHIVANI VENKATASRI PALAKODATY DO (NPI 1245811215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245811215 NPI number — SHIVANI VENKATASRI PALAKODATY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALAKODATY
Provider First Name:
SHIVANI
Provider Middle Name:
VENKATASRI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245811215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1770 NE MIAMI GARDENS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33179-5301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14023 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-325-4100
Provider Business Practice Location Address Fax Number:
281-325-4292
Provider Enumeration Date:
04/20/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS21107 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)