Basic Information
| Provider Information | |||||||||
| NPI: | 1629384888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALAKODETY | ||||||||
| FirstName: | SAI | ||||||||
| MiddleName: | SRAVANTHI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 W THUNDERBIRD RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028652627 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5555 W THUNDERBIRD RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028652627 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L3203R | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 46519 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 54535 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 54535 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.