Healthcare Provider Details

I. General information

NPI: 1639114721
Provider Name (Legal Business Name): KALA SESHADRI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 TAMIAMI TRL
PORT CHARLOTTE FL
33952-5172
US

IV. Provider business mailing address

2841 TAMIAMI TRL
PORT CHARLOTTE FL
33952-5172
US

V. Phone/Fax

Practice location:
  • Phone: 941-627-5151
  • Fax: 941-629-2036
Mailing address:
  • Phone: 941-627-5151
  • Fax: 941-629-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME44092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: