Provider Demographics
NPI:1609879022
Name:NADIMINTI, YALLAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:YALLAPPA
Middle Name:
Last Name:NADIMINTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:401 MANATEE AVE E
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1143
Practice Address - Country:US
Practice Address - Phone:941-748-2217
Practice Address - Fax:941-748-5300
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36292207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039642700Medicaid
FLP00387327OtherRR MEDICARE
E11941Medicare UPIN
FL41169XMedicare PIN