Healthcare Provider Details

I. General information

NPI: 1538121256
Provider Name (Legal Business Name): ROOPA CHALLAPALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

IV. Provider business mailing address

2 CARTERS GRV
PITTSFORD NY
14534-3053
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4394
  • Fax:
Mailing address:
  • Phone: 585-419-6824
  • Fax: 585-419-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number182677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: