Healthcare Provider Details

I. General information

NPI: 1902186737
Provider Name (Legal Business Name): SRIKANTH CHALLAGUNDLA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CLAUS RD
MODESTO CA
95355-9711
US

IV. Provider business mailing address

1501 CLAUS RD
MODESTO CA
95355-9711
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-6300
  • Fax: 209-557-6388
Mailing address:
  • Phone: 209-557-6300
  • Fax: 209-557-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number273208
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37024
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA130015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: