Healthcare Provider Details

I. General information

NPI: 1992368583
Provider Name (Legal Business Name): SHRUTI DAHOTRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 06/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

1300 MAIN ST
RICHMOND TX
77469-3348
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 281-341-9696
  • Fax: 281-341-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT5860
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: