Provider Demographics
NPI:1417141425
Name:GAJJELA, HEMLATA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:HEMLATA
Middle Name:REDDY
Last Name:GAJJELA
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 1:3100 E FLETCHER AVE STE 126
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4613
Mailing Address - Country:US
Mailing Address - Phone:813-467-4242
Mailing Address - Fax:
Practice Address - Street 1:3100 E FLETCHER AVE STE 126
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-467-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-02
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13151208000000X
FLME114618208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417141425Medicaid
FL007390200Medicaid
NV1417141425Medicaid
FL007390200Medicaid