Basic Information
| Provider Information | |||||||||
| NPI: | 1871972992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVARAPALLI | ||||||||
| FirstName: | MALLIKA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2103 WYTHE DR | ||||||||
| Address2: | |||||||||
| City: | EVANS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308095475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137796303 | ||||||||
| FaxNumber: | 8889771998 | ||||||||
| Practice Location | |||||||||
| Address1: | 12470 TELECOM DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137796303 | ||||||||
| FaxNumber: | 8889771998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2015 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS14608 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | OS14608 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.