Provider Demographics
NPI:1548210263
Name:CHENNU, YAMINI P (MD)
Entity type:Individual
Prefix:
First Name:YAMINI
Middle Name:P
Last Name:CHENNU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YAMINI
Other - Middle Name:P
Other - Last Name:YARLAGADDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:713 GRAINGER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:817-336-3968
Mailing Address - Fax:817-336-3917
Practice Address - Street 1:713 GRAINGER STREET
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-336-3968
Practice Address - Fax:817-336-3917
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN06962084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010049661Medicaid
TX0043RROtherBCBS
VA004962V69Medicare ID - Type Unspecified
TX0043RROtherBCBS
VA010049661Medicaid