MEDICARE: SUDHA R GANTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	182835	NY
2	207R00000X	Internal Medicine Physician	ME77895	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME77895	OTHER	FL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093715989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUDHA R GANTI M.D.

Provider Business Mailing Address
First Line	:	985 STATE ROAD 436
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-5664
Country	:	US
Telephone Number	:	407-831-5252
Fax Number	:	407-831-3765

Provider Business Practice Location Address
First Line	:	985 STATE ROAD 436
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-5664
Country	:	US
Telephone Number	:	407-831-5252
Fax Number	:	407-831-3765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	02/03/2025

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Directions to “ SUDHA R GANTI M.D.” Practice Location

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