Healthcare Provider Details

I. General information

NPI: 1396485207
Provider Name (Legal Business Name): SAHITHI EDAVALLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N HEATHERWILDE BLVD STE 304
PFLUGERVILLE TX
78660-6448
US

IV. Provider business mailing address

201 N HEATHERWILDE BLVD STE 304
PFLUGERVILLE TX
78660-6448
US

V. Phone/Fax

Practice location:
  • Phone: 512-650-4446
  • Fax: 833-764-5671
Mailing address:
  • Phone: 512-650-4446
  • Fax: 833-764-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberW5320
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: