Provider Demographics
NPI:1184873762
Name:DANDAMUDI, VENKATA SIVA RAMAKRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:SIVA RAMAKRISHNA
Last Name:DANDAMUDI
Suffix:
Gender:M
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:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-0976
Mailing Address - Country:US
Mailing Address - Phone:617-636-5848
Mailing Address - Fax:
Practice Address - Street 1:3838 SAN DIMAS ST STE A140
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1151
Practice Address - Country:US
Practice Address - Phone:661-632-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2462432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology