Healthcare Provider Details

I. General information

NPI: 1326164252
Provider Name (Legal Business Name): SESHADRI & SESHADRI MDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/17/2008
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: 941-629-4949
  • Fax: 941-629-2036
Mailing address:
  • Phone: 941-629-4949
  • Fax: 941-629-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DEBORAH JOY LUNDGREN
Title or Position: OFFICE MANAGER
Credential:
Phone: 941-629-4949