Provider Demographics
NPI:1952830879
Name:KADIYALA, SRAVANTHI
Entity Type:Individual
Prefix:
First Name:SRAVANTHI
Middle Name:
Last Name:KADIYALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6532 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3624
Mailing Address - Country:US
Mailing Address - Phone:954-427-8000
Mailing Address - Fax:854-427-8189
Practice Address - Street 1:6532 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3624
Practice Address - Country:US
Practice Address - Phone:954-427-8000
Practice Address - Fax:854-427-8189
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist