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Deactivated NPI 1467040501 Deactivated / Inactive NPI Male Practitioner

Supradeep Shree Venkata Madduri

Urology • Jacksonville, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Supradeep Madduri has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 05, 2021
NPI Deactivation Date February 02, 2022
Total Practice Duration ~1 Years of Practice (2021 – 2022)

Professional Overview & Biography Verified Profile Summary

Supradeep Madduri was a registered Urology practicing in Jacksonville, FL. Throughout an active medical career spanning 1 years, Supradeep Madduri provided care at the practice location at 4500 SAN PABLO RD S until profile deactivation on 2022-02-02.

Practice Location & Contact Primary Location

Practice Address

4500 San Pablo Rd S

Jacksonville, FL 322241865

Telephone 9049532000
Associated Practice Facility / Clinic
🏢 Mayo Clinic Jacksonville Facility NPI 1790772317

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Jacksonville, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 26.4 Yrs
State Avg: 29.7 Yrs
Regional Practice Density
64 Specialists

Practicing in Jacksonville, FL (1082 Statewide)

Telehealth Adoption Rate
37.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-08-09
Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License FL 46196

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Katherine Walsh , PA-C, MPH

Physician Assistant

NPI 1003015280

Physician Assistant (Certified), Master of Public Health

Dr. Jami Kinnucan , MD

Internal Medicine - Gastroenterology

NPI 1003045634

Doctor of Medicine (M.D.)

Dr. Glenn Shi , MD

Orthopaedic Surgery

NPI 1003058660

Doctor of Medicine (M.D.)

Dr. Michelle Tulang , MD

Internal Medicine

NPI 1003073586

Doctor of Medicine (M.D.)

NPI 1003100520

Doctor of Medicine (M.D.)

Crystal Lynn , CRNA

Nurse Anesthetist, Certified Registered

NPI 1003148768

Certified Registered Nurse Anesthetist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 09, 2026

Urology (License #46196 in FL)

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Updated Practice Location April 02, 2026

Registered at 4500 SAN PABLO RD S, JACKSONVILLE, FL 322241865 (Tel: 9049532000)

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Updated Business Mailing Address April 02, 2026

Registered at PO BOX 860912, MINNEAPOLIS, MN 554860912 (Tel: 9049532000)

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Provider Name / Credentials Updated April 02, 2026

Recorded as SUPRADEEP MADDURI

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 02, 2026

Student in an Organized Health Care Education/Training Program

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NPI Profile Deactivated February 02, 2022

Record deactivated on February 02, 2022

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Updated Business Mailing Address February 05, 2021

Registered at 101 MANNING DR, CHAPEL HILL, NC 275144220 (Tel: 9849743014)

NPI Profile Active January 05, 2021

NPI status registered as active in NPPES database

📍
Updated Practice Location January 05, 2021

Registered at 101 MANNING DR, CHAPEL HILL, NC 275144220 (Tel: 8283201615)

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Updated Business Mailing Address January 05, 2021

Registered at 1840 9TH ST NW, HICKORY, NC 286011208 (Tel: 8283201615)

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Provider Name / Credentials Updated January 05, 2021

Recorded as SUPRADEEP MADDURI

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 05, 2021

Pharmacy Technician (License #30048194 in NC)

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Initial NPI Registration & Enumeration January 05, 2021

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1467040501
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 05, 2021
Last Update: August 09, 2026
Deactivation Date: February 02, 2022
Sole Proprietor: Yes

Mailing Address

Po Box 860912

Minneapolis, MN 554860912

Phone: 9049532000

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.