Healthcare Provider Details

I. General information

NPI: 1386620870
Provider Name (Legal Business Name): PRASANTHI REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRASANTHI CHAMAKURA M.D.

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4788 HODGES BLVD BUILDING B, SUITE 108
JACKSONVILLE FL
32224-7222
US

IV. Provider business mailing address

4788 HODGES BLVD BUILDING B, SUITE 108
JACKSONVILLE FL
32224-7222
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-9100
  • Fax: 904-223-9282
Mailing address:
  • Phone: 904-223-9100
  • Fax: 904-223-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME9115
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME91195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: