Healthcare Provider Details

I. General information

NPI: 1851740088
Provider Name (Legal Business Name): SIRISHA THUMMALAPENTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 03/29/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 9TH ST
WICHITA FALLS TX
76301-5003
US

IV. Provider business mailing address

5011 LANTANA DR
WICHITA FALLS TX
76310-3358
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-1075
  • Fax: 940-322-8215
Mailing address:
  • Phone: 203-446-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberT2769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: