MEDICARE: DR. PARWATI C MADDALI M.D.

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	2084P0800X	Psychiatry Physician	ME66568	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25999	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1669475497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARWATI C MADDALI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 561527
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32956-1527
Country	:	US
Telephone Number	:	321-631-4222
Fax Number	:	321-631-4302

Provider Business Practice Location Address
First Line	:	845 EXECUTIVE LN
Second Line	:	100
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-3528
Country	:	US
Telephone Number	:	321-631-4222
Fax Number	:	321-631-4302

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/24/2026

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