Provider Demographics
NPI:1194922286
Name:CHIMATA, SIREESHA (MD)
Entity type:Individual
Prefix:DR
First Name:SIREESHA
Middle Name:
Last Name:CHIMATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4619
Mailing Address - Country:US
Mailing Address - Phone:850-431-5105
Mailing Address - Fax:850-431-7478
Practice Address - Street 1:1616 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4619
Practice Address - Country:US
Practice Address - Phone:850-431-5105
Practice Address - Fax:850-431-7478
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1090232084P0800X
VA01012469532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry