Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME78817 | FL |
N | 2080A0000X | Adolescent Medicine | 78817 | FL |
NPI | 1063564730 |
---|---|
Provider Name | Srirekha Reddy Madadi |
First Address | Jacksonville, FL 32277-2044 |
Second Address | Jacksonville, FL 32277-2042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260426400 | (05) | FL |