Provider Demographics
NPI:1518343243
Name:MANDADI, AKHILA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:AKHILA REDDY
Middle Name:
Last Name:MANDADI
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 1:655 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-4124
Mailing Address - Fax:904-244-4508
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4124
Practice Address - Fax:904-244-4508
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
FLME136285208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
No208000000XAllopathic & Osteopathic PhysiciansPediatrics