Provider Demographics
NPI:1013478544
Name:PATLOLLA, SUSHMA (MD)
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:PATLOLLA
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 1:1414 KUHL AVE # MP38
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:321-842-4713
Mailing Address - Fax:
Practice Address - Street 1:9400 TURKEY LAKE RD # MP452
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8001
Practice Address - Country:US
Practice Address - Phone:321-842-8505
Practice Address - Fax:321-843-5550
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine