Provider Demographics
NPI:1689135022
Name:TADEPALLI, SRIKANTH R (MD)
Entity Type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:R
Last Name:TADEPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAAN
Other - Middle Name:
Other - Last Name:TADEPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1431 SW 1ST AVE # BITZER7
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6500
Mailing Address - Country:US
Mailing Address - Phone:352-401-8311
Mailing Address - Fax:352-401-8313
Practice Address - Street 1:1431 SW 1ST AVE # BITZER7
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6500
Practice Address - Country:US
Practice Address - Phone:352-401-8311
Practice Address - Fax:352-401-8313
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11465800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine