Healthcare Provider Details

I. General information

NPI: 1124403779
Provider Name (Legal Business Name): SWETHA EDLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

IV. Provider business mailing address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

V. Phone/Fax

Practice location:
  • Phone: 352-536-8840
  • Fax: 352-536-8841
Mailing address:
  • Phone: 352-536-8840
  • Fax: 352-536-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME179524
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019014002
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: