Healthcare Provider Details

I. General information

NPI: 1124055272
Provider Name (Legal Business Name): SHRAVAN REDDY KAMBAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7154 MEDICAL CENTER DR
SPRING HILL FL
34608-1329
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1926
  • Fax: 352-597-2154
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME151895
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA0794300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: