Healthcare Provider Details

I. General information

NPI: 1760069835
Provider Name (Legal Business Name): VENKATA SAI SAHITHI KOTHAMASU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 GEORGIAN DR
COPPELL TX
75019-6280
US

IV. Provider business mailing address

1430 TULANE AVE # 8611
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 262-309-2642
  • Fax:
Mailing address:
  • Phone: 504-988-5216
  • Fax: 504-988-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: