Provider Demographics
NPI:1861477671
Name:VADLAMANI-SIMMERS, LALITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:VADLAMANI-SIMMERS
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 1:1590 RUCKEL DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1603
Mailing Address - Country:US
Mailing Address - Phone:850-621-5058
Mailing Address - Fax:
Practice Address - Street 1:490 HIGHWAY 85 N STE A
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1010
Practice Address - Country:US
Practice Address - Phone:850-419-2691
Practice Address - Fax:850-353-2142
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262647100Medicaid
FL262647100Medicaid