Provider Demographics
NPI:1548670946
Name:THUMALLAPALLY, NISHITHA REDDY (MD)
Entity type:Individual
Prefix:MS
First Name:NISHITHA
Middle Name:REDDY
Last Name:THUMALLAPALLY
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 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:121 WHITEHALL DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5266
Practice Address - Country:US
Practice Address - Phone:904-825-4500
Practice Address - Fax:907-825-3672
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2023-08-16
Deactivation Date:2014-12-09
Deactivation Code:
Reactivation Date:2015-09-23
Provider Licenses
StateLicense IDTaxonomies
FLME159539207RH0003X
390200000X
SC83700207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118147900Medicaid
FL6UOLEOtherFL BLUE
FLQU962OtherMEDICARE