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Individual

MS. NISHITHA REDDY THUMALLAPALLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
121 WHITEHALL DR, ST AUGUSTINE, FL 32086-5266
(904) 825-4500
(907) 825-3672
Mailing address
7015 A C SKINNER PKWY STE 1, JACKSONVILLE, FL 32256-6932
(904) 363-2113
(904) 363-2606

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
ME159539
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
118147900
FL
01
6UOLE
FL BLUE
FL
01
QU962
MEDICARE
FL
Enumeration date
05/07/2014
Last updated
08/16/2023
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