Healthcare Provider Details

I. General information

NPI: 1598785966
Provider Name (Legal Business Name): SUMITHRA VATTIGUNTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMITHRA VATTIGUNTA MD

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 PGA BLVD STE 200 FLORIDA CANCER SPECIALISTS
PALM BEACH GARDENS FL
33410-2824
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 561-366-4100
  • Fax: 561-798-5581
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME0092306
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME0092306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: