Provider Demographics
NPI:1871778316
Name:JATAVALLABHULA, NARASIMHA SASTRY (MD)
Entity type:Individual
Prefix:
First Name:NARASIMHA
Middle Name:SASTRY
Last Name:JATAVALLABHULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 731218
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1218
Mailing Address - Country:US
Mailing Address - Phone:903-315-2714
Mailing Address - Fax:903-315-2719
Practice Address - Street 1:701 E MARSHALL AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5659
Practice Address - Country:US
Practice Address - Phone:903-315-2714
Practice Address - Fax:903-315-2719
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT191834207T00000X
CAA1164062084D0003X, 2084H0002X, 2084N0008X, 2084N0400X, 2084N0600X, 2084P0005X, 2084P2900X, 2084S0010X, 2084V0102X, 204D00000X, 207T00000X
TXP6650207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM