Healthcare Provider Details

I. General information

NPI: 1558581173
Provider Name (Legal Business Name): ONCOLOGY AND HEMATOLOGY CONSULTANTS OF PALM BEACHES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 BURNS RD STE 203
PALM BEACH GARDENS FL
33410-4328
US

IV. Provider business mailing address

12496 EQUINE LN
WELLINGTON FL
33414-3508
US

V. Phone/Fax

Practice location:
  • Phone: 561-691-4301
  • Fax: 561-691-4517
Mailing address:
  • Phone: 561-691-4301
  • Fax: 561-691-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberME92306
License Number StateFL

VIII. Authorized Official

Name: DR. SUMITHRA VATTIGUNTA
Title or Position: PRESIDENT
Credential: MD
Phone: 561-691-4301