Healthcare Provider Details

I. General information

NPI: 1487835229
Provider Name (Legal Business Name): SANDEEP K. CHILAKALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 JEFFERSON AVENUE, SUITE 201
MEMPHIS TN
38103
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-4750
  • Fax: 901-302-2993
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number49878
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: