Healthcare Provider Details

I. General information

NPI: 1376954594
Provider Name (Legal Business Name): SATHAVARAM ARAVIND REDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 VILLAGE SQUARE PKWY STE 107
FLEMING ISLAND FL
32003-4319
US

IV. Provider business mailing address

5191 FIRST COAST TECH PKWY 3RD FLOOR
JACKSONVILLE FL
32224-0609
US

V. Phone/Fax

Practice location:
  • Phone: 904-257-0060
  • Fax: 904-223-2169
Mailing address:
  • Phone: 904-223-3321
  • Fax: 904-223-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME141290
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number201250
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME141290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: