Healthcare Provider Details

I. General information

NPI: 1942563960
Provider Name (Legal Business Name): SHWETA DUGGIRALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE SUITE 160
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

6215 HUMPHREYS BLVD SUITE500
MEMPHIS TN
38120-2367
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax: 360-514-1065
Mailing address:
  • Phone: 901-628-0630
  • Fax: 901-682-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number51478
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60744875
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: