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General NPI Number Information
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NPI Number | 1114372695
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Entity Type | Individual
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Provider Name | SUJITHA YADLAPATI MD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 304 S MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4920
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Country | US
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Telephone | 573-803-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 VERSAILLES DR
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City | SAN JUAN
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State | TX
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Zip | 78589-2143
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Country | US
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Telephone | 210-803-1675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2024037737
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License Number State | MO
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