=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619010220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUNIL CHOUDARY PALADUGU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 01/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 W MADISON ST.
-----------------------------------------------------
City | STARKE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-964-8823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2369 YELLOW JASMINE LN
-----------------------------------------------------
City | FLEMING ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-955-1899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS41100
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------