Provider Demographics
NPI:1952664161
Name:KODALI, BABY VASANTHI (MB,BS)
Entity Type:Individual
Prefix:DR
First Name:BABY VASANTHI
Middle Name:
Last Name:KODALI
Suffix:
Gender:F
Credentials:MB,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 NW 14TH ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14050 NW 14TH ST
Practice Address - Street 2:SUITE 190
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2865
Practice Address - Country:US
Practice Address - Phone:800-424-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38071208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist