MEDICARE: SUJATHA REDDY BORRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME86603	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104811462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUJATHA REDDY BORRA MD

Provider Business Mailing Address
First Line	:	13333 N 56TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-1161
Country	:	US
Telephone Number	:	813-983-0894
Fax Number	:

Provider Business Practice Location Address
First Line	:	13333 N 56TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-1161
Country	:	US
Telephone Number	:	813-983-0894
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/23/2025

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