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General NPI Number Information
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NPI Number | 1104228287
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Entity Type | Individual
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Provider Name | SHIRISHA PEDDI M.D
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Gender | Female
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Dates
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Enumeration Date | 09/20/2014
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 11801 SOUTH FWY
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City | BURLESON
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State | TX
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Zip | 76028
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Country | US
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Telephone | 817-568-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 11801 SOUTH FWY
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City | BURLESON
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State | TX
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Zip | 76028-7021
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Country | US
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Telephone | 817-568-5955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.065420
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | R5622
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036143377
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License Number State | IL
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