Organization
CHANDRATARA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SWATI ELLENDULA MD (PSYCHIATRIST)
(469) 213-6400
Entity
Organization
Contact information
Practice address
4500 HILLCREST RD STE 115, FRISCO, TX 75035-5418
(469) 213-6400
(469) 213-6473
Mailing address
4500 HILLCREST RD STE 115, FRISCO, TX 75035-5418
(469) 213-6400
(469) 213-6473
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
N9542
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
318504
MEDICARE PTAN
TX
01
—
363043
MEDICARE PTAN
TX
Enumeration date
04/05/2012
Last updated
04/15/2016
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