Healthcare Provider Details

I. General information

NPI: 1265954622
Provider Name (Legal Business Name): SAI PAVAN KUMAR CHINTALAPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 06/06/2023
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100289
GAINESVILLE FL
32610-0289
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5481
  • Fax:
Mailing address:
  • Phone: 352-294-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301112641
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME154354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: