Individual
VENKATA MARTHANDA SASTRY MUKKAVILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6363 FOREST PARK RD FL 7, SUITE 749, DALLAS, TX 75235-5479
(214) 645-8500
(214) 648-3775
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-0624
(214) 645-0078
Taxonomy
Speciality
Code
Description
License number
State
207QS1201X
Sleep Medicine (Family Medicine) Physician
Q3741
TX
2084P0800X
Psychiatry Physician
0101258929
VA
2084P0800X
Psychiatry Physician
24594
WV
2084P0800X
Psychiatry Physician
Primary
Q3741
TX
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
Q3741
TX
390200000X
Student in an Organized Health Care Education/Training Program
233251
—
Other
Enumeration date
02/03/2009
Last updated
12/30/2022
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