Healthcare Provider Details

I. General information

NPI: 1366565103
Provider Name (Legal Business Name): CHAGANTI AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 MIAMI STREET
ST LOUIS MO
63118
US

IV. Provider business mailing address

713 THE HAMPTONS LANE
TOWN AND COUNTRY MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-6195
  • Fax: 314-268-6155
Mailing address:
  • Phone: 314-276-8893
  • Fax: 314-645-6478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SURENDRA CHAGANTI
Title or Position: PRESIDENT
Credential: MD
Phone: 314-283-8291