Provider Demographics
NPI:1578872891
Name:HARDY, KAVITHA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:PRASAD
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAVITHA
Other - Middle Name:SUDNAGUNTA
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:223 S BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:FL
Mailing Address - Zip Code:32580-1552
Mailing Address - Country:US
Mailing Address - Phone:850-974-5605
Mailing Address - Fax:
Practice Address - Street 1:223 S BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:FL
Practice Address - Zip Code:32580-1552
Practice Address - Country:US
Practice Address - Phone:850-974-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54376-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice