Healthcare Provider Details

I. General information

NPI: 1720274343
Provider Name (Legal Business Name): ANURADHA JEYARAMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD STE 200
LUTZ FL
33558-8005
US

IV. Provider business mailing address

4211 VAN DYKE RD STE 200
LUTZ FL
33558-8005
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-6237
  • Fax: 813-463-1801
Mailing address:
  • Phone: 813-321-6237
  • Fax: 813-463-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.090229
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME110489
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-090229
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME110489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: