Supradeep Shree Venkata Madduri

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

46196 Issued in FL

Practice address

4500 San Pablo Rd S
Jacksonville, FL 32224-1865

Phone

(904) 953-2000

NPI assigned

Jan 5, 2021

Reactivated

Mar 31, 2026

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786233600000",
    "number": "1467040501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860912",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860912",
            "telephone_number": "904-953-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDURI",
        "first_name": "SUPRADEEP",
        "middle_name": "SHREE VENKATA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-05",
        "last_updated": "2026-08-09",
        "certification_date": "2026-08-09",
        "deactivation_date": "2022-02-02",
        "reactivation_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "46196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Robert Maddern, MD
• Charles B Maddix, APRN, MSN, PMHNP-BC
• Jennifer J Maddox, CRNA
• Karen B Maddox, MA
• Lisa Jeanne Maddox
• Colin Mader, DPT
• Jenna Mader
• Courtney L Madera, PT DPT
• Vadim Lev Madfis, M.D.
• Harry Madhanagopal, D.O.

• Urology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.