Healthcare Provider Details

I. General information

NPI: 1619382397
Provider Name (Legal Business Name): DEEPAK KUMAR PASUPULA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 A C SKINNER PKWY STE 160
JACKSONVILLE FL
32256-6953
US

IV. Provider business mailing address

PO BOX 551308
JACKSONVILLE FL
32255-1308
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-3333
  • Fax: 904-493-2222
Mailing address:
  • Phone: 904-493-3333
  • Fax: 904-493-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME160409
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME160409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: