Provider Demographics
NPI:1982730735
Name:SHRIDHARAN, LATA (MD)
Entity type:Individual
Prefix:DR
First Name:LATA
Middle Name:
Last Name:SHRIDHARAN
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 1:2308 ALL SAINTS LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5536
Mailing Address - Country:US
Mailing Address - Phone:972-618-3547
Mailing Address - Fax:972-618-3547
Practice Address - Street 1:2109 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE #200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4189
Practice Address - Country:US
Practice Address - Phone:469-444-0362
Practice Address - Fax:972-618-3547
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics