Healthcare Provider Details

I. General information

NPI: 1477858819
Provider Name (Legal Business Name): SREEDHAR CHAMALA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2011
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date: 05/14/2013
Reactivation Date: 10/20/2014

III. Provider practice location address

1801 NW 9TH AVE
MIAMI FL
33136-1101
US

IV. Provider business mailing address

1901 NW NORTH RIVER DR APT 306
MIAMI FL
33125-2259
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME139754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: