Healthcare Provider Details

I. General information

NPI: 1013103084
Provider Name (Legal Business Name): V. RAO EMANDI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13904 LAKESHORE BLVD STE 410
HUDSON FL
34667-1481
US

IV. Provider business mailing address

13904 LAKESHORE BLVD STE 410
HUDSON FL
34667-1481
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-5489
  • Fax: 727-862-0397
Mailing address:
  • Phone: 727-862-5489
  • Fax: 727-862-0397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. VENKATA RAO EMANDI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 727-862-5489