Provider Demographics
NPI:1700035433
Name:TADICHERLA, SUJATHA (MD)
Entity Type:Individual
Prefix:
First Name:SUJATHA
Middle Name:
Last Name:TADICHERLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 CRESTOVER LN STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6794
Mailing Address - Country:US
Mailing Address - Phone:813-606-4144
Mailing Address - Fax:813-666-1508
Practice Address - Street 1:2336 CRESTOVER LN STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6794
Practice Address - Country:US
Practice Address - Phone:813-606-4144
Practice Address - Fax:813-666-1508
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103564207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology