Healthcare Provider Details

I. General information

NPI: 1548954233
Provider Name (Legal Business Name): DEEPA NUTHALAPATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HERITAGE DR STE 100
JUPITER FL
33458-3030
US

IV. Provider business mailing address

550 HERITAGE DR STE 100
JUPITER FL
33458-3030
US

V. Phone/Fax

Practice location:
  • Phone: 561-238-0928
  • Fax: 888-234-0275
Mailing address:
  • Phone: 561-238-0928
  • Fax: 888-234-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME181335
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: