Healthcare Provider Details

I. General information

NPI: 1477349637
Provider Name (Legal Business Name): SHYAMA YALLAPRAGADA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-5472
US

IV. Provider business mailing address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-5472
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4906
  • Fax:
Mailing address:
  • Phone: 541-768-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPG230766
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: