Healthcare Provider Details

I. General information

NPI: 1740113240
Provider Name (Legal Business Name): SAI PAVITRA PAIDIMARRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SAINT EDWARDS ST
BROOKLYN NY
11201-3904
US

IV. Provider business mailing address

4720 BEAR RUN DR
PLANO TX
75093-7300
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberP143017
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: