Provider Demographics
NPI:1407825375
Name:KAKI, SUJATHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUJATHA
Middle Name:
Last Name:KAKI
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 1:14015 EGRET TOWER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6197
Mailing Address - Country:US
Mailing Address - Phone:407-447-7100
Mailing Address - Fax:407-447-6100
Practice Address - Street 1:14015 EGRET TOWER DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6197
Practice Address - Country:US
Practice Address - Phone:407-447-7100
Practice Address - Fax:407-447-6100
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94340208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1391688OtherGHI
FL4130558OtherAETNA
FL274203900Medicaid
FL28846OtherBCBS