MEDICARE: MADHAVI DUDDELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302035726	MI

General Provider Information

NPI Number	:	1174799167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHAVI DUDDELLA

Provider Business Mailing Address
First Line	:	242 ROONEY CT
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5832
Country	:	US
Telephone Number	:	917-361-0409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2239 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3201
Country	:	US
Telephone Number	:	718-941-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	12/14/2011

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Directions to “ MADHAVI DUDDELLA ” Practice Location

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