Provider Demographics
NPI:1043626054
Name:MANNEMUDDHU, SAI SUDHA (MD)
Entity type:Individual
Prefix:
First Name:SAI SUDHA
Middle Name:
Last Name:MANNEMUDDHU
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:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:
Practice Address - Street 1:2100 CLINCH AVE STE 310
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2220
Practice Address - Country:US
Practice Address - Phone:865-546-3111
Practice Address - Fax:877-761-6691
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN607832080P0210X, 2080P0210X
FLME1314612080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ056987Medicaid