Healthcare Provider Details

I. General information

NPI: 1679752760
Provider Name (Legal Business Name): MADHURIMA SANKA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 66TH ST N
PINELLAS PARK FL
33781-5025
US

IV. Provider business mailing address

6233 66TH ST
PINELLAS PARK FL
33781-5025
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-8100
  • Fax:
Mailing address:
  • Phone: 727-544-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberOS9639
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberOS9639
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberOS9639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: