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1013019744

NPI Code Detail

MEDICARE: SHYAMALA MIRYALA MD

MEDICARE: SHYAMALA MIRYALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	0101228924	VA
2	207R00000X	Internal Medicine Physician	P4596	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013019744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYAMALA MIRYALA MD

Provider Business Mailing Address
First Line	:	4400 LONG PRAIRIE RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1892
Country	:	US
Telephone Number	:	469-322-7481
Fax Number	:	469-322-7807

Provider Business Practice Location Address
First Line	:	4400 LONG PRAIRIE RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1892
Country	:	US
Telephone Number	:	469-322-7481
Fax Number	:	469-322-7807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	04/08/2014

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Directions to “ SHYAMALA MIRYALA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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