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General NPI Number Information
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NPI Number | 1659056968
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Entity Type | Organization
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Legal Business Name | SP OBGYN ,PLLC
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 9925 GILLESPIE DR STE 2400
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City | PLANO
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State | TX
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Zip | 75025-1099
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Country | US
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Telephone | 972-905-1550
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Fax | 855-592-0913
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Provider Business Mailing Address
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Address Line | 6863 ELDARICA PL
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City | FRISCO
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State | TX
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Zip | 75034-8352
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Country | US
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Telephone | 618-201-0632
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SRIDEVI PANCHAMUKHI
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Credential | MD
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Telephone | 618-201-0632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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