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General NPI Number Information
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NPI Number | 1801281928
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Entity Type | Organization
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Legal Business Name | SARADA PENUKONDA MD
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 323 DEL PRADO BLVD S STE 100
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City | CAPE CORAL
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State | FL
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Zip | 33990-1747
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Country | US
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Telephone | 239-574-3382
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Fax | 239-574-5897
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Provider Business Mailing Address
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Address Line | 323 DEL PRADO BLVD S STE 100
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City | CAPE CORAL
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State | FL
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Zip | 33990-1747
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Country | US
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Telephone | 239-574-3382
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Fax | 239-574-5897
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Authorized Official
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Title or Position | PRESENT
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Name | MRS. SARADA PENUKONDA
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Credential | M.D.
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Telephone | 239-574-3382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0067197
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License Number State | FL
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