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NPI Code Detail

MEDICARE: SAI VITTALA PLLC

MEDICARE: SAI VITTALA PLLC
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
12084P0805XGeriatric Psychiatry Physician
22084P0800XPsychiatry Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q3302OTHERTXMEDICAL LICENSE

General Provider Information

NPI Number : 1497134332
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAI VITTALA PLLC
Provider Business Mailing Address
First Line : 2600 E SOUTHLAKE BLVD STE 120354
Second Line :
City : SOUTHLAKE
State : TX
Zip : 76092-6634
Country : US
Telephone Number : 682-477-3534
Fax Number : 682-477-3602
Provider Business Practice Location Address
First Line : 5560 MESA SPRINGS DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-2120
Country : US
Telephone Number : 817-292-4600
Fax Number :
Authorized Official
Title or Position : MD
Name : DR. RAMAKRISHNA VELURI
Credential :
Telephone Number : 682-477-3534
Provider Enumeration Date : 05/26/2015
Last Update Date : 03/07/2023

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