Healthcare Provider Details

I. General information

NPI: 1336153709
Provider Name (Legal Business Name): FLORIDA MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13940 N US HIGHWAY 441 STE 102
LADY LAKE FL
32159-8909
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5735
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-9900
  • Fax: 844-388-6186
Mailing address:
  • Phone: 813-444-5838
  • Fax: 833-495-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SRIRAM SUNDARAMOORTHY
Title or Position: VP - OPERATIONS
Credential:
Phone: 813-444-5838