Healthcare Provider Details

I. General information

NPI: 1689052409
Provider Name (Legal Business Name): MAMATHA KONDAPALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 BELT LINE RD STE 200
DALLAS TX
75254-7658
US

IV. Provider business mailing address

2201 HEMPSTEAD TURNPIKE, DEPARTMENT OF MEDICINE NASSAU UNIVERSITY MEDICAL CENTER
EAST MEADOW NY
11554-1849
US

V. Phone/Fax

Practice location:
  • Phone: 469-774-1532
  • Fax:
Mailing address:
  • Phone: 516-572-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT4541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: