Provider Demographics
NPI:1043408446
Name:MEDICHERLA, LAKSHMI UDAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:UDAY
Last Name:MEDICHERLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:UDAY
Other - Middle Name:LAKSHMI
Other - Last Name:KAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1833 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206
Mailing Address - Country:US
Mailing Address - Phone:904-232-2751
Mailing Address - Fax:
Practice Address - Street 1:1833 BOULEVARD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4382
Practice Address - Country:US
Practice Address - Phone:904-232-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0905632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry