Healthcare Provider Details

I. General information

NPI: 1215900808
Provider Name (Legal Business Name): SRINIVASAN SATTIRAJU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/30/2024
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 VILLAGE SQUARE PKWY STE 204
FLEMING ISLAND FL
32003-6409
US

IV. Provider business mailing address

PO BOX 746652
ATLANTA GA
30374-6652
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5185
  • Fax: 904-376-3202
Mailing address:
  • Phone: 904-720-0599
  • Fax: 904-376-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME131129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: