Provider Demographics
NPI:1780899989
Name:CHELIKANI KOTAGIRI, SUNANDA (MD)
Entity type:Individual
Prefix:
First Name:SUNANDA
Middle Name:
Last Name:CHELIKANI KOTAGIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUNANDA
Other - Middle Name:
Other - Last Name:KOTAGIRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11811 FALLBROOK DR.
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3600
Mailing Address - Country:US
Mailing Address - Phone:832-237-8882
Mailing Address - Fax:
Practice Address - Street 1:11811 FALLBROOK DR.
Practice Address - Street 2:SUITE B-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3600
Practice Address - Country:US
Practice Address - Phone:832-237-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309979802Medicaid
TX309979802Medicaid