Provider Demographics
NPI:1124053749
Name:CUDDAPAH, SUBBARAYUDU (MD)
Entity type:Individual
Prefix:
First Name:SUBBARAYUDU
Middle Name:
Last Name:CUDDAPAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUBBARAYUDU
Other - Middle Name:
Other - Last Name:CUDDAPAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:521 PINELLAS BAYWAY S APT 408
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1999
Mailing Address - Country:US
Mailing Address - Phone:727-374-3128
Mailing Address - Fax:727-374-3128
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:BAY PINES VA HEALTH CARE
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-319-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92364208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery