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General NPI Number Information
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NPI Number | 1407249998
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Entity Type | Organization
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Legal Business Name | WESLEY CHAPEL DERMATOLOGY LLC
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 2336 CRESTOVER LN STE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6794
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Country | US
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Telephone | 813-606-4144
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Fax | 813-666-1508
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Provider Business Mailing Address
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Address Line | 2336 CRESTOVER LN STE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6794
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Country | US
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Telephone | 813-606-4144
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Fax | 813-666-1508
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Authorized Official
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Title or Position | PARTNER
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Name | SUJATHA TADICHERLA
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Credential | MD
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Telephone | 813-666-0488
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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 |
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License Number State |
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