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General NPI Number Information
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NPI Number | 1629163241
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Entity Type | Individual
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Provider Name | SODAGAM N HARIKRISHNA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20454 NE FINLAY AVENUE
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424
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Country | US
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Telephone | 850-415-2583
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Fax |
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 298
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City | SNEADS
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State | FL
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Zip | 32460
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Country | US
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Telephone | 850-415-2583
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND1305
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License Number State | FL
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