Healthcare Provider Details

I. General information

NPI: 1093292930
Provider Name (Legal Business Name): SNIGDHA GUMMADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

PO BOX 100415
GAINESVILLE FL
32610-5937
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5800
  • Fax:
Mailing address:
  • Phone: 352-273-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDRP1902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: