Healthcare Provider Details

I. General information

NPI: 1629099163
Provider Name (Legal Business Name): SUDARSAN KAMISETTY, M.D.,P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 W. LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

681 W. LUMSDEN RD
BRANDON FL
33511
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-7726
  • Fax: 813-655-5617
Mailing address:
  • Phone: 813-655-7726
  • Fax: 813-655-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME70832
License Number StateFL

VIII. Authorized Official

Name: DR. SUDARSAN R KAMISETTY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 813-655-7726