MEDICARE: SANJANA THOTA-KAMMILI MBBS

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME161327	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528682259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJANA THOTA-KAMMILI MBBS

Provider Business Mailing Address
First Line	:	770 W GRANADA BLVD STE 101
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5179
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 PINNACLES DR STE 1
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2322
Country	:	US
Telephone Number	:	386-231-6549
Fax Number	:	386-231-6550

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

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	12/03/2025

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