Healthcare Provider Details

I. General information

NPI: 1427082171
Provider Name (Legal Business Name): SREENADHA REDDY VATTAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SARA SWAMY DR STE 220
SHERMAN TX
75090-3124
US

IV. Provider business mailing address

1001 SARA SWAMY DR STE 220
SHERMAN TX
75090-3124
US

V. Phone/Fax

Practice location:
  • Phone: 903-892-1999
  • Fax: 903-892-6999
Mailing address:
  • Phone: 903-892-1999
  • Fax: 903-892-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM2851
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM2851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: