Provider Demographics
NPI:1841623469
Name:KANDULA, SWETHA REDDY (MD)
Entity type:Individual
Prefix:
First Name:SWETHA
Middle Name:REDDY
Last Name:KANDULA
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 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-327-2035
Mailing Address - Fax:563-336-3014
Practice Address - Street 1:500 W RIVER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1014
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-336-3014
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43365208000000X
IL036139674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics