Provider Demographics
NPI:1407249998
Name:WESLEY CHAPEL DERMATOLOGY LLC
Entity Type:Organization
Organization Name:WESLEY CHAPEL DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUJATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADICHERLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-666-0488
Mailing Address - Street 1:2336 CRESTOVER LN STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6794
Mailing Address - Country:US
Mailing Address - Phone:813-606-4144
Mailing Address - Fax:813-666-1508
Practice Address - Street 1:2336 CRESTOVER LN STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6794
Practice Address - Country:US
Practice Address - Phone:813-606-4144
Practice Address - Fax:813-666-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty