Healthcare Provider Details

I. General information

NPI: 1639613300
Provider Name (Legal Business Name): KALYANI REGETI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18669 TAMIAMI TRL STE B
NORTH PORT FL
34287-7388
US

IV. Provider business mailing address

18669 TAMIAMI TRL STE B
NORTH PORT FL
34287-7388
US

V. Phone/Fax

Practice location:
  • Phone: 941-423-5040
  • Fax:
Mailing address:
  • Phone: 941-423-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME141413
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number306050
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: