Healthcare Provider Details

I. General information

NPI: 1255438792
Provider Name (Legal Business Name): SUDHA TALLAPRAGADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S OSPREY AVE STE 1
SARASOTA FL
34239-2900
US

IV. Provider business mailing address

1425 S OSPREY AVE STE 1
SARASOTA FL
34239-2900
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-9060
  • Fax: 941-953-7076
Mailing address:
  • Phone: 941-366-9060
  • Fax: 941-953-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0074771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: