Healthcare Provider Details

I. General information

NPI: 1356537591
Provider Name (Legal Business Name): DR. SURESH BABU MEKAPATI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 ASHFORD OAKS DR APT # 205
ALTAMONTE SPRINGS FL
32714-5509
US

IV. Provider business mailing address

703 ASHFORD OAKS DR APT # 205
ALTAMONTE SPRINGS FL
32714-5509
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-3309
  • Fax:
Mailing address:
  • Phone: 407-339-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS39952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: