Basic Information
| Provider Information | |||||||||
| NPI: | 1124053749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUDDAPAH | ||||||||
| FirstName: | SUBBARAYUDU | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
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| OtherLastName: | CUDDAPAH | ||||||||
| OtherFirstName: | SUBBARAYUDU | ||||||||
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| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 521 PINELLAS BAYWAY S APT 408 | ||||||||
| Address2: | |||||||||
| City: | TIERRA VERDE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337151999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273743128 | ||||||||
| FaxNumber: | 7273743128 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 BAY PINES BLVD | ||||||||
| Address2: | BAY PINES VA HEALTH CARE | ||||||||
| City: | BAY PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273986661 | ||||||||
| FaxNumber: | 7273191099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | ME 92364 | FL | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.