Healthcare Provider Details

I. General information

NPI: 1053708677
Provider Name (Legal Business Name): SHANMUGA PUJITHA JONNALAGADDA M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WELBORN ST
DALLAS TX
75219-3924
US

IV. Provider business mailing address

2222 WELBORN ST
DALLAS TX
75219-3924
US

V. Phone/Fax

Practice location:
  • Phone: 214-559-5000
  • Fax: 214-443-7309
Mailing address:
  • Phone: 214-559-5000
  • Fax: 214-443-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT4648
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberDR.0061005
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberT4648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: