Provider Demographics
NPI:1720096498
Name:ACHANTA, SAI PADMAJA (PA)
Entity type:Individual
Prefix:
First Name:SAI PADMAJA
Middle Name:
Last Name:ACHANTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ STE NC100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:713-798-3111
Mailing Address - Fax:713-798-7999
Practice Address - Street 1:20171 CHASEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1437
Practice Address - Country:US
Practice Address - Phone:713-798-3111
Practice Address - Fax:713-798-7999
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03347363A00000X
OK2383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK357427YMWBMedicare PIN