MEDICARE: SHANTI S NAGIREDDY 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	2084P0804X	Child & Adolescent Psychiatry Physician	M3039	TX

General Provider Information

NPI Number	:	1477646560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTI S NAGIREDDY MD

Provider Business Mailing Address
First Line	:	PO BOX 733784
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-3784
Country	:	US
Telephone Number	:	682-885-1855
Fax Number	:	682-885-1396

Provider Business Practice Location Address
First Line	:	901 7TH AVE STE 2200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2722
Country	:	US
Telephone Number	:	682-885-1050
Fax Number	:	682-885-7572

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/29/2021

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Directions to “ SHANTI S NAGIREDDY MD” Practice Location

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