Provider Demographics
NPI:1528609542
Name:CHINTALAPALLI, SHARMISTA (MA)
Entity type:Individual
Prefix:
First Name:SHARMISTA
Middle Name:
Last Name:CHINTALAPALLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHARMISTA
Other - Middle Name:
Other - Last Name:CHINTALAPALLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:4028 RALEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-8217
Mailing Address - Country:US
Mailing Address - Phone:563-528-4288
Mailing Address - Fax:
Practice Address - Street 1:10455 POMERADO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1717
Practice Address - Country:US
Practice Address - Phone:563-528-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801113678103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty