Individual
DR. NIVEDITHA SHANKARA REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4211 VAN DYKE RD STE 200, LUTZ, FL 33558-8005
(813) 321-6237
(813) 463-1801
Mailing address
4211 VAN DYKE RD STE 200, LUTZ, FL 33558-8005
(813) 321-6237
(813) 463-1801
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME103829
FL
207RI0200X
Infectious Disease Physician
ME103829
FL
208M00000X
Hospitalist Physician
Primary
ME103829
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000904100
—
FL
01
—
P00997944
MEDICARE RAILROAD PROVIDER NUMBER
FL
Enumeration date
08/08/2006
Last updated
07/02/2024
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