Healthcare Provider Details

I. General information

NPI: 1740235662
Provider Name (Legal Business Name): SARADA GUMMADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 MICHAELANGELO DR STE 200
EDINBURG TX
78539-1412
US

IV. Provider business mailing address

PO BOX 749
PHARR TX
78577-1614
US

V. Phone/Fax

Practice location:
  • Phone: 956-362-2250
  • Fax: 956-362-2251
Mailing address:
  • Phone: 956-362-2250
  • Fax: 956-362-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberM2965
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: