Healthcare Provider Details

I. General information

NPI: 1518988823
Provider Name (Legal Business Name): SIVA PRASANNA TADISETTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 WINDGUARD CIR STE 102
WESLEY CHAPEL FL
33544-7353
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-3331
  • Fax: 813-466-7482
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: