Provider Demographics
NPI:1629073606
Name:DONEPUDI, SRIDEVI (MD)
Entity type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:DONEPUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRIDEVI
Other - Middle Name:DONEPUDI
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:239 CHRISTIANA RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2907
Practice Address - Country:US
Practice Address - Phone:302-327-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108481207Q00000X
KS04-32448207Q00000X
DEC1-0011878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL731672215OtherCCN FIRST CHOICE
IL731672215OtherTRICARE
IL731672215OtherPREFERRED PLAN, INC PPO
IL731672215OtherPROFESSIONAL BENEFIT ADMI
IL731672215OtherUNITED (GRP 0240939)
IL731672215AOtherHUMANA
IL731672215OtherPHCS CORESOURCE
IL036108481Medicaid
IL04932321OtherBLUE CROSS BLUE SHIELD
IL731672215OtherPRUDENTIAL
IL731672215OtherUNICARE
IL2162900OtherFIRST HEALTH
IL731672215OtherGREAT WEST
KS200438380AMedicaid
IL731672215OtherAETNA
IL731672215OtherPRINCIPAL LIFE INSURANCE
IL731672215OtherTRUSTMARK LIFE INSURANCE
IL731672215OtherTRUSTMARK LIFE INSURANCE
IL731672215OtherCCN FIRST CHOICE
ILK03606Medicare UPIN
KS106606Medicare PIN
IL731672215OtherPHCS CORESOURCE