Healthcare Provider Details

I. General information

NPI: 1942401104
Provider Name (Legal Business Name): SRAVANTHI PAJERLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6184 CARRIAGE TRAIL DR
TROY MI
48098-5359
US

IV. Provider business mailing address

2655 NORTHWINDS PKWY
ALPHARETTA GA
30009-2280
US

V. Phone/Fax

Practice location:
  • Phone: 717-919-0929
  • Fax:
Mailing address:
  • Phone: 678-992-1631
  • Fax: 678-658-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13462
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301097839
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01073715A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD439827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: