Individual
SHYLASHREE CHIKKAMUNIYAPPA EDALUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1026 RIVERWOOD DR, LONGVIEW, TX 75604-6229
(903) 239-3862
Mailing address
1026 RIVERWOOD DR, LONGVIEW, TX 75604-6229
(903) 239-3862
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M3188
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M3188
PHYSICIAN PERMIT
TX
Enumeration date
08/21/2006
Last updated
12/22/2021
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