Individual
DR. SHIVSAI GONGALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E LEHIGH AVE UNIT N238, PHILADELPHIA, PA 19125-1012
(215) 707-1200
Mailing address
1050 N HANCOCK ST # N238, PHILADELPHIA, PA 19123-2342
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MT229487
PA
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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