Healthcare Provider Details

I. General information

NPI: 1922432251
Provider Name (Legal Business Name): RAJASEKHAR BYRAPUREDDY CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HIGHLAND PARK VLG SUITE 100-225
DALLAS TX
75205-2789
US

IV. Provider business mailing address

25 HIGHLAND PARK VLG SUITE 100-225
DALLAS TX
75205-2789
US

V. Phone/Fax

Practice location:
  • Phone: 214-460-4457
  • Fax: 214-975-1312
Mailing address:
  • Phone: 214-460-4457
  • Fax: 214-975-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number1805
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: