Healthcare Provider Details

I. General information

NPI: 1568048940
Provider Name (Legal Business Name): SRAVYA MOTHERAMGARI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 N FLORISSANT AVE
SAINT LOUIS MO
63107-1812
US

IV. Provider business mailing address

6420 CLAYTON RD RM 2233
SAINT LOUIS MO
63117-1811
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-1700
  • Fax:
Mailing address:
  • Phone: 314-951-7240
  • Fax: 314-951-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023043411
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: