Provider Demographics
NPI:1609886373
Name:JUDD, SONALI KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:SONALI
Middle Name:KIRAN
Last Name:JUDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONALI
Other - Middle Name:KIRAN
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 152557
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-2557
Mailing Address - Country:US
Mailing Address - Phone:813-876-9553
Mailing Address - Fax:813-877-4109
Practice Address - Street 1:4728 N HABANA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7100
Practice Address - Country:US
Practice Address - Phone:813-876-9553
Practice Address - Fax:813-877-4109
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052602910Medicaid