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General NPI Number Information
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NPI Number | 1669475497
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Entity Type | Individual
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Provider Name | PARWATI C MADDALI M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 845 EXECUTIVE LN 100
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City | ROCKLEDGE
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State | FL
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Zip | 32955-3528
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Country | US
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Telephone | 321-631-4222
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Fax | 321-631-4302
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Provider Business Mailing Address
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Address Line | PO BOX 561527
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City | ROCKLEDGE
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State | FL
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Zip | 32956-1527
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Country | US
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Telephone | 321-631-4222
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Fax | 321-631-4302
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME66568
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License Number State | FL
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