Healthcare Provider Details

I. General information

NPI: 1619615598
Provider Name (Legal Business Name): AMITY PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 LEBANON RD # 101-102
FRISCO TX
75035-9472
US

IV. Provider business mailing address

12500 LEBANON RD # 101-102
FRISCO TX
75035-9472
US

V. Phone/Fax

Practice location:
  • Phone: 213-308-0850
  • Fax:
Mailing address:
  • Phone: 945-248-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SRIKANTH CHALLAGUNDLA
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 213-308-0850