Provider Demographics
NPI:1265539373
Name:VAKA, SREERAMULU REDDY (M D)
Entity type:Individual
Prefix:DR
First Name:SREERAMULU
Middle Name:REDDY
Last Name:VAKA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6900 SOUTHPOINT DR N
Mailing Address - Street 2:ROOM 530
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8007
Mailing Address - Country:US
Mailing Address - Phone:904-470-6900
Mailing Address - Fax:904-739-0171
Practice Address - Street 1:6900 SOUTHPOINT DR N
Practice Address - Street 2:ROOM 530
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8007
Practice Address - Country:US
Practice Address - Phone:904-470-6900
Practice Address - Fax:904-739-0171
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0783122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H32942Medicare UPIN
OHVA4044033Medicare ID - Type Unspecified