Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 23795 | MS |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 50637 | TN |
NPI | 1780810614 |
---|---|
Provider Name | Ms. Prethi Vaddadi |
First Address | Memphis, TN 38120-9446 |
Second Address | Memphis, TN 38120-2382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 15/04/2021 |