Provider Demographics
NPI:1437507696
Name:PRADEEP, NEETI (MD)
Entity Type:Individual
Prefix:
First Name:NEETI
Middle Name:
Last Name:PRADEEP
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 1:3225 S MACDILL AVE # 129-369
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8171
Mailing Address - Country:US
Mailing Address - Phone:813-474-9804
Mailing Address - Fax:
Practice Address - Street 1:3225 S MACDILL AVE STE 129-369
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8171
Practice Address - Country:US
Practice Address - Phone:813-474-9804
Practice Address - Fax:516-562-0368
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144950207R00000X
FLP631620909710390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine