Provider Demographics
NPI:1902981467
Name:PEDDADA, MADHAVI LATHA (MS,RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:MADHAVI
Middle Name:LATHA
Last Name:PEDDADA
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 JEAGA DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8718
Mailing Address - Country:US
Mailing Address - Phone:615-346-9187
Mailing Address - Fax:
Practice Address - Street 1:1645 JEAGA DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8718
Practice Address - Country:US
Practice Address - Phone:615-346-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered