Healthcare Provider Details

I. General information

NPI: 1558285544
Provider Name (Legal Business Name): SREESHANTH R KATTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 E PRINCE RD
TUCSON AZ
85719-2002
US

IV. Provider business mailing address

1469 E JUDE LN
GILBERT AZ
85298-0720
US

V. Phone/Fax

Practice location:
  • Phone: 520-461-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: