Provider Demographics
NPI:1972090025
Name:RUDD, JALEEKA LASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:JALEEKA
Middle Name:LASHA
Last Name:RUDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5440
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:108 N MOSBY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-9804
Practice Address - Country:US
Practice Address - Phone:252-586-5411
Practice Address - Fax:252-586-2028
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine