Provider Demographics
NPI:1548228265
Name:UPPALAPATI, MADHAVI (MD)
Entity type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:UPPALAPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 LEGACY HILLS CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3198
Mailing Address - Country:US
Mailing Address - Phone:407-829-8920
Mailing Address - Fax:407-829-8921
Practice Address - Street 1:1301 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 1001
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1409
Practice Address - Country:US
Practice Address - Phone:407-829-8920
Practice Address - Fax:408-829-8921
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85195207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277857200Medicaid
FLH85195Medicare UPIN