MEDICARE: DR. SRIDEVI CHALLAPALLI M.D.

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	207RC0000X	Cardiovascular Disease Physician	A71053	CA
2	207RC0000X	Cardiovascular Disease Physician	8810	NV

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

General Provider Information

NPI Number	:	1063404721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRIDEVI CHALLAPALLI M.D.

Provider Business Mailing Address
First Line	:	5375 RENO CORPORATE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2381
Country	:	US
Telephone Number	:	775-384-1134
Fax Number	:	775-284-1523

Provider Business Practice Location Address
First Line	:	5375 RENO CORPORATE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2381
Country	:	US
Telephone Number	:	775-384-1134
Fax Number	:	775-284-1523

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	11/02/2023

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