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General NPI Number Information
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NPI Number | 1902427651
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Entity Type | Individual
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Provider Name | CHAITANYA UNDAVALLI
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Gender | Female
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2900 E TEXAS ST STE 100
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3275
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Country | US
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Telephone | 318-606-6737
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Fax | 833-749-0343
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 844-630-0700
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Fax | 877-374-1924
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP20085227
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License Number State | TX
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