Provider Demographics
NPI:1861648651
Name:DANDAMUDI, ANITA K (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:K
Last Name:DANDAMUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:K
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2215 ABBOTT MARTIN RD
Mailing Address - Street 2:UNIT 111
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2527
Mailing Address - Country:US
Mailing Address - Phone:312-505-0853
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:7TH, 8TH AND 9TH FLOOR
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053760208100000X
TN53499208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020643Medicaid
TN103I253303Medicare PIN