Provider Demographics
NPI:1033165964
Name:GADDIPATI, KALYANI (MD)
Entity Type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:
Last Name:GADDIPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 RINEHART RD
Mailing Address - Street 2:SUITE 2051
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4802
Mailing Address - Country:US
Mailing Address - Phone:407-936-2444
Mailing Address - Fax:
Practice Address - Street 1:917 RINEHART RD
Practice Address - Street 2:SUITE 2051
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4802
Practice Address - Country:US
Practice Address - Phone:407-936-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74348207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5702044007OtherCIGNA
43554OtherBCBS
100016196OtherRAILROAD MEDICARE
FL254587000Medicaid
3542OtherFHHS
2745785OtherAETNA
G69697Medicare UPIN
43554OtherBCBS