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Individual
MS. REKHA NIDADAVOLU
Active
Individual
MS. REKHA NIDADAVOLU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
24667
MA
183500000X
Pharmacist
PS44664
FL
363A00000X
Physician Assistant
Primary
PA9111839
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24667
PHARMACIST LICENSE
MA
01
—
PA9111839
FLORIDA PHYSICIAN ASSISTANT BOARD
FL
01
—
PS44664
FLORIDA BOARD OF PHARMACY
FL
Enumeration date
02/11/2010
Last updated
01/30/2020
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