=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396199014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SINDHU JUJJAVARAPU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2016
-----------------------------------------------------
Last Update Date | 08/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12924 WILLOW CHASE DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77070-5641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-930-7872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1605 CLEAR SPRINGS LN
-----------------------------------------------------
City | SOUTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23834-5872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 48-691-3062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 36118
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------