Provider Demographics
NPI:1417268301
Name:NADELLA, SOUMYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOUMYA
Middle Name:
Last Name:NADELLA
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 1:6661 CLYO RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2702
Mailing Address - Country:US
Mailing Address - Phone:937-425-4000
Mailing Address - Fax:937-425-4002
Practice Address - Street 1:6661 CLYO RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2702
Practice Address - Country:US
Practice Address - Phone:937-425-4000
Practice Address - Fax:937-425-4002
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.058834207Q00000X
OH35125189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112724Medicaid
OHH405440Medicare PIN