Individual
DR. SIVA PRASANNA TADISETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2615 WINDGUARD CIR, STE 102, WESLEY CHAPEL, FL 33544-7353
(813) 333-3331
(813) 466-7482
Mailing address
2995 DREW ST, CLEARWATER, FL 33759-3012
(727) 315-7496
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME94439
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274142300
—
FL
01
—
31547
BLUE CROSS BLUE SHIELD
FL
01
—
77464773
AETNA
FL
Enumeration date
07/21/2006
Last updated
09/20/2023
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