Provider Demographics
NPI:1568442598
Name:KONDABALA, RAJANI K (MD)
Entity Type:Individual
Prefix:
First Name:RAJANI
Middle Name:K
Last Name:KONDABALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAJANI
Other - Middle Name:K
Other - Last Name:GADDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:218 9TH STREET DR W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4802
Mailing Address - Country:US
Mailing Address - Phone:941-721-3900
Mailing Address - Fax:
Practice Address - Street 1:218 9TH STREET DR W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4802
Practice Address - Country:US
Practice Address - Phone:941-721-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94547208000000X
NY237192208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics