Provider Demographics
NPI:1962467076
Name:TIRUPATHI, SREELATHA (MD)
Entity Type:Individual
Prefix:
First Name:SREELATHA
Middle Name:
Last Name:TIRUPATHI
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 1:3301 66TH ST N
Mailing Address - Street 2:STE A
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1547
Mailing Address - Country:US
Mailing Address - Phone:727-344-6200
Mailing Address - Fax:727-344-6222
Practice Address - Street 1:3301 66TH ST N STE A
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1547
Practice Address - Country:US
Practice Address - Phone:727-344-6200
Practice Address - Fax:727-344-6222
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262497400Medicaid
FL262497400Medicaid
FLE6629Medicare ID - Type Unspecified