Southlake Kidney Specialists, PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

SOUTHLAKE KIDNEY SPECIALISTS, PLLC

Practice address

630 N Kimball Ave Ste 100
Southlake, TX 76092-6886

Phone

(817) 733-9367

NPI assigned

Sep 5, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sharmila Devidoss, MD

Title

Physician

Phone

(817) 733-9367

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1003465790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MONTE CARLO DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921159",
            "telephone_number": "817-733-9367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N KIMBALL AVE STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926886",
            "telephone_number": "817-733-9367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE KIDNEY SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-05",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "DEVIDOSS",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "817-733-9367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.